A: Look out for the symptoms:
- Increased thirst and peeing more often and larger amounts - as your body tries to make the food you have eaten into energy, blood sugar levels rise and the kidneys pump lots of sugar into the urine, taking with it large amounts of water.
- Severe tiredness - your body is still unable to convert this sugar into energy.
- Weight loss - body fats are also broken into sugars, which are passed out in the urine.
- Thrush in the mouth, vagina or on the skin - high sugar levels in blood and secretions makes a juicy breeding ground for bugs of all sorts.
- Problems with your vision. · Recurrent infections.
Q: What are the causes of diabetes?
A: Diabetes mellitus occurs when the pancreas doesn't make enough or any of the hormone insulin, or when the insulin produced doesn't work effectively. In diabetes, this causes the level of glucose in the blood to be too high.
In Type 1 diabetes the cells in the pancreas that make insulin are destroyed, causing a severe lack of insulin. This is thought to be the result of the body attacking and destroying its own cells in the pancreas - known as an autoimmune reaction.
It's not clear why this happens, but a number of explanations and possible triggers of this reaction have been proposed. These include:
- infection with a specific virus or bacteria;
- exposure to food-borne chemical toxins; and
- exposure as a very young infant to cow's milk, where an as yet unidentified component of this triggers the autoimmune reaction in the body.
However, these are only hypotheses and are by no means proven causes.
Type 2 diabetes is believed to develop when:
- The receptors on cells in the body that normally respond to the action of insulin fail to be stimulated by it - this is known as insulin resistance. In response to this more insulin may be produced, and this over-production exhausts the insulin-manufacturing cells in the pancreas;
- there is simply insufficient insulin available; and
- insulin that is available may be abnormal and therefore doesn't work properly.
The following risk factors increase the chances of someone developing Type 2 diabetes:
- Increasing age;
- Obesity; and
- Physical inactivity.
Rarer causes of diabetes include:
- Certain medicines;
- Pregnancy (gestational diabetes); and
Q: What doesn't cause diabetes?
A: It's important to also be aware of the different myths that over the years have arisen about the causes of diabetes.
Eating sweets or the wrong kind of food does not cause diabetes. However, it may cause obesity and this is associated with people developing Type 2 diabetes.
Stress does not cause diabetes, although it may be a trigger for the body turning on itself as in the case of Type 1 diabetes. It does, however, make the symptoms worse for those who already have diabetes.
Diabetes is not contagious. Someone with diabetes cannot pass it on to anyone else.
Q: What is the treatment I receive for my Diabetes?
A: The type of treatment you will receive will depend on the type of diabetes you have.
Type 1 diabetes is treated with insulin and by eating a healthy diet.
Insulin cannot be taken by mouth because the digestive juices in the stomach destroy it. This means that it has to be given by injections. Most people find giving the injections simple and relatively painless, since the needle is so fine.
How often someone needs to give himself or herself an injection depends on what their diabetes specialist has recommended, and which type of insulin they're using. Each injection may contain one type, or a combination of different types of insulin. They act for a short (short-acting), intermediate (intermediate-acting), or longer (long-acting) period of time.
The injection can be given using either the traditional needle and plastic syringe, or the newer injection pen devices that many people find more convenient to use.
Type 2 diabetes
A healthy diet is the cornerstone of managing type 2 diabetes. The aims are to reduce the overall intake of energy and fat maintaining normal body weight.
It is known that reducing body weight in obese people reduces the risk of cardiovascular disease, lowers blood pressure and improves the composition of blood fats. Life expectancy is extended. People with type 2 diabetes are deficient in insulin as well as being resistant to its action. Most people with type 2 diabetes will require oral diabetic medication. Recent research (UKPDS) has shown that most people with type 2 diabetes will eventually require combination therapy and/or insulin.
Q: What are the aims of diabetes care?
A: There are 2 main aims of diabetes treatment. These are to:
Eliminate any symptoms of diabetes; and
Prevent the possible complications it can cause.
Diabetes cannot be cured, but it can be managed and kept under control.
Both Type 1 and Type 2 can cause serious health problems such as heart disease, stroke, blindness, kidney damage and nerve damage if they are not treated well. Tight control of the blood sugar level helps reduce the chance of these problems arising.
In both types of diabetes, dietary measures play a crucial role. You will have the opportunity to discuss any problems you have about your about healthy eating and weight control issues with Diabetes Nurse who will be able to refer you to a specially-trained dieticians who will be able to offer invaluable advice about which foods are good and which are not so good.
Q: I have read about the dangers of ketoacidosis. What exactly is this?
A: Diabetic ketoacidosis (DKA) occurs as a result of high blood glucose levels and too little insulin. As the blood glucose level rises, the body tries to remove the excess glucose by passing it out in the urine. This leads to dehydration and increased thirst. Water is moved from all the body cells to try and dilute the level of glucose in the blood. As this happens, the levels of sodium and potassium (called electrolytes) in the body are affected too. Although there is a lot of glucose present, the body cannot use this for energy, because of the lack of insulin, and breaks down fat as another source of energy. As fat breaks down, acidic chemicals called ketones are released into the blood stream. These are dangerous and the body tries to remove them in the urine and on the breath (giving a smell of pear drops or acetone).
The presence of ketones can also lead to vomiting. If untreated, the high level of acidic ketones, the dehydration and the imbalance of electrolytes can lead to unconsciousness and, if untreated, death. In a small number of cases DKA can occur even if blood glucose levels are normal, especially if the individual has not been eating.
Q: What are the signs and symptoms of ketoacidosis?
A: Increased thirst, increased urination, tiredness, a feeling of being unwell and eventual coma is the main features of diabetic ketoacidosis (DKA). If these occur in someone with diabetes they need to seek medical attention immediately as they will need insulin and fluids to correct the problem. If detected early, increasing the insulin dosage can prevent matters worsening and bring the person back into control of their diabetes. DKA can happen over a matter of hours with young children and can take one to two days in adults. It most commonly occurs during periods of illness. People with Type 1 diabetes should test their urine for ketones if their blood glucose is high (normally over 15 mmol/l) or if they have any of the symptoms of ketoacidosis. If a test is positive you should contact your healthcare team immediately for advice on the action you need to take.
Q: How do I avoid ketoacidosis?
A: Maintaining generally good control (with blood glucose levels between 4 and 10 mmol/l) and regular blood glucose testing will help to avoid the risk of ketoacidosis. Remember that illness can have an effect on your blood glucose control. During periods of illness, even if you are not eating, insulin is still needed and it is important never to stop taking your insulin. You should do more frequent blood glucose testing. Diabetes UK recommends that you test at least four times a day during periods of illness. Ask your specialist team for help if you are worried.
Q: How do I adjust my insulin?
A: One of the most important aspects of learning about insulin is knowing how to adjust your insulin dose. In brief, raised blood sugars need a HIGHER dose of insulin and Low blood sugars need a LOWER dose of insulin. It is important to adjust doses on the basis of several results and not just one. This following information will give you the necessary information on how to make safe and effective changes
Q: How do I adjust a single daily dose of insulin
A: A single daily dose of basal insulin which provides a background level of insulin continuously throughout the day and night.
If the pre breakfast blood sugar is raised, then increase your insulin dose as follows:
If the pre-breakfast blood sugars are between 7-10mmols, then increase by 2 units.
If 10 and above increase by 4 units.
Allow 4-6 days before making further increases.
If your blood sugars are too low, then reduce your insulin. Aim for pre-breakfast blood sugar levels to be between 5-7mmols.
Q: How do I adjust my Twice Daily Insulin
A: Your morning dose of insulin controls your daytime blood sugar, before lunch and before your evening meal.
Your evening dose of insulin controls your blood sugar after your evening meal and overnight.
If your teatime blood sugars are raised then increase your morning dose.
If your pre-breakfast blood sugars are high, then increase your evening dose by 2-4 units only.
Allow 3-4 days before increasing your dose further. If your blood sugars are above 15mmols increase by 4 units.
Generally you should aim for pre-meal blood sugars between 5-7mmols. Blood sugar 2 hours after meal should be 9-10mmols.
How do I adjust my insulin dose?
Q: How do I adjust my Four Times Daily Insulin (Basal Bolus)
A: Your basal insulin taken once a day, which will usually be Insulin Glargine (Lantus) or Insulin Detemir (Levemir), controls your background blood sugar. This dose of insulin does not usually need changing often. However, if your blood sugar is either too high or too low during the night or up until pre-breakfast, then this insulin needs to be adjusted.
Breakfast insulin (usually Novorapid or Humalog) needs adjusting if your blood sugar mid morning or pre lunch is not in target range.
Lunchtime insulin (Usually Novorapid or Humalog) needs adjusting if your blood sugar mid afternoon or pre evening meal is not in target range.
Teatime or evening meal insulin (usually Novorapid or Humalog) needs adjusting if your blood sugar mid evening or before bed is not in target range.
Generally you should aim for pre-meal blood sugars to be between 5-7mmols and blood sugars 2 hours after a meal should usually be no higher than 9-10mmols.
If your blood sugars are 9-15mmols or above, increase your insulin by 2 units, if 15mmols or above, increase your insulin by 4 units at the appropriate time.
Do make small changes which are based on trends in your blood sugar patterns.
Do monitor your blood sugars for a couple of days after making any change.
Don’t adjust your insulin too frequently on the basis of your blood sugars.
Don’t omit your insulin because your blood sugar is within the normal range.