The information in this section has been written by our nurse but is not meant to be medical advice. You should always speak with your Diabetes Specialist Nurse or doctor if you are concerned about your diabetes management and before changing your diet, lifestyle or medication.
According to the first WHO Global report on diabetes, the number of people living with diabetes has nearly quadrupled to over 400 million adults in just over 30 years. One of the main reasons for this is type 2 diabetes caused mostly by obesity (1).
Diabetes is a condition that occurs when the beta cells, which are in the pancreas, do not make any or enough insulin or when the body cannot use the insulin that is made. This causes an increase in the amount of glucose in the blood because insulin is needed to allow the sugar to move out of the blood and into the cells to be used for energy.
The beta cells have the very important job of making and storing insulin and then release it when there is a rise in blood sugar eg. after eating.
A high level of glucose in the blood can over time cause serious damage to the heart, blood vessels, eyes, kidneys and nerves if left untreated (3).
Frequent symptoms of diabetes
- You may feel more thirsty than usual
- Due to drinking more you will need to pass urine more often
- You may feel more tired as you are not getting enough energy from your food
- You may lose weight and muscle bulk if the body starts to use fat for energy instead of sugar
- You may notice your vision is blurred due to dry eyes
- You may notice itch or discomfort in the genital area caused by a fungal infection called thrush, this is quite commonly due to having a high blood sugar level
Three common types of diabetes
- Type 1: This can develop at any age but mostly occurs in younger people before the age of 40 (2). Many are not aware they have Type 1 diabetes and most are diagnosed as young adults following a urine test or blood tests after seeing their doctor because they feel unwell or due to becoming very unwell and having urine and blood tests in hospital.
- Type 2: This is the most common type of diabetes and usually occurs in white people over 40 years and can happen about 10 years earlier in South Asian, African Caribbean and Black African races.
- Gestational: This affects pregnant women and is usually diagnosed by urine and blood tests during the first antenatal appointment.
Type 1 diabetes
About 10% of adult diabetics have Type 1 diabetes which can start at any age but mostly happens before the age of 40 years and is the most common type of diabetes in children (2). Type 1 diabetes is an autoimmune disease and is not caused by lifestyle (4). Due to an autoimmune response, the body destroys the beta cells (insulin producing cells) in the pancreas. No insulin can be produced so the glucose cannot enter the cells, this causes the glucose level in the blood to be high.
It is not your fault if you have type 1 diabetes and you should not feel guilty if you are unable to control your blood sugar levels. Speak to your doctor or diabetes nurse specialist to discuss your concerns.
Currently there is no cure for type 1 diabetes and for most, it is vital to have insulin to sustain a full and normal life. You must attend all your diabetic clinic appointments and follow the advice of the doctor, nurse, dietician and podiatrist, they will help you control your blood sugar and answer any questions you have.
Type 2 diabetes
This is the most common type of diabetes, it usually occurs in people over the age of 40 years. African Caribbean, South Asian and black African people have a higher risk of developing type 2 diabetes and it can occur about 10 years sooner. It is now becoming more common in children and young people of all races possibly due to being overweight (5). It occurs because the beta cells in the pancreas are unable to produce enough insulin or the insulin produced is not able to do its job.
The main treatment for many is a healthy diet and an increase in exercise. Medication and or insulin may also be required if diet and exercise alone cannot control the blood sugar and help you feel well again. It is very important to attend your clinic appointments so the doctor, nurse, dietician and podiatrist can help you and support you in looking after yourself and help to prevent complications.
This type of diabetes affects some pregnant women. It is quite common and 1 in 5 women giving birth in England and Wales may have it (12). It occurs usually in the later stages of pregnancy and often goes away when the baby is born.
Having Gestational diabetes can increase the chance of developing Type 2 diabetes later in life. The hormones produced during pregnancy may make it difficult for the body to use insulin or the pancreas is unable to produce enough insulin to meet the higher demand.
Pregnancy, if you are already a diabetic, can make it more difficult for you to control your blood sugar than it was before the pregnancy. Usually there are no symptoms and a blood test taken at your first antenatal appointment is often the first time you are aware. You may have noticed that you feel more tired or need to drink more or pass urine more and may have just put it down to being pregnant which is often the case.
Treatment for a lot of women is a change in diet, controlling your weight and an increase in exercise. Some women may also need medication or insulin. Mum is closely monitored during and after her pregnancy and blood sugars are monitored. The baby also needs close monitoring, the high sugar levels may cause the baby to be large and can lead to complications during the birth, hence the importance of monitoring mum's blood glucose levels and trying to keep them as near to normal as possible. A cesarean section may be necessary if the baby gets too big.
Insulin is a hormone produced by the beta cells in the pancreas. The beta cells produce and store insulin and then release it when it is needed to balance the level of glucose in the blood. Insulin allows the cells in the body to take in the glucose and use it for energy.
The pancreas is an organ located behind the stomach. The pancreas plays a very important part in digestion of the food you eat and in keeping your blood sugar at the right level (6). To balance your blood sugar the hormones insulin and glucagon are needed and these hormones are produced in the pancreas;
Insulin allows glucose to enter the cells to be used for energy, it allows glucose to enter muscles and other tissues and works with the liver to store glucose. Glucagon raises the blood glucose level when required. The combination of insulin and glucagon maintain the balance of glucose in the blood.
Polycystic ovary syndrome (PCOS)
PCOS is a health problem that can affect some women, it mostly starts in your late teens and ends with the menopause.
- You may notice a problem with your periods being irregular or not having any periods
- You may be having difficulty becoming pregnant or have had some miscarriages
- Your hormones may be imbalanced causing mood swings or depression
- You may notice your skin is more oily and prone to acne or spots
- You may notice you have hair growth on your face, chest or back
- You may have put on weight recently
If you are concerned, see your doctor. They will look at your concerns and carry out some tests. Some common signs of polycystic ovary syndrome can be a combination of some of the following;
- High levels of androgens (male hormones)
- Missed or irregular periods
- Many small cysts on your ovaries (7)
- Insulin resistance
In the UK, about 10% of women have some degree of PCOS (8). The cause of PCOS is not known but it is thought that genetics amongst other factors play a part. Many women with PCOS have too much insulin in their body, this is thought to be caused by insulin resistance, this happens because the body is not using the insulin produced properly, not enough is getting into the cells to be used for energy, so the beta cells produce even more insulin to try to keep the glucose in the cells topped up (9). If your mother or sister have been told they have PCOS it will increase the chance that you too may develop it. If you have PCOS you may have an increased risk of developing Type 2 diabetes and other health problems later in life, so getting more exercise and losing weight could help reduce this risk (10).
The term HbA1c refers to glycated haemoglobin. Haemoglobin is a protein within the red blood cells that carries oxygen around the body. If there is too much glucose in the blood it can bind to the red blood cells which become 'glycated'. The measurement of glycated haemoglobin (HbA1c) will give the doctor an overall picture of the average blood sugar level over a period of weeks or months and show how well your diabetes is controlled.
This is a term used by doctors to describe an increased risk of developing Type 2 diabetes. This is like a warning sign to let you know you need to make some changes to your lifestyle to try to prevent Type 2 diabetes or other health problems developing later. Your blood sugar levels may be higher than normal but not high enough to give a diagnosis of Type 2 diabetes yet. To reduce the risks some changes may be needed.
You may need to lose weight if your body mass index (BMI) is greater than 25, increased fat especially around the tummy area and waist line may lead to Type 2 diabetes (11). Extra fat cells make it more difficult for the body to use insulin so it can become more insulin resistant, this can then lead to a high blood sugar level. Increasing your physical activity may help you reduce the risk of developing Type 2 diabetes as well as many other health problems also.
- If your blood pressure is high work along with your doctor or nurse to try to reduce it.
- If your cholesterol level is high, try to reduce it, a change in your diet with advice from your doctor or a dietician may help
- Knowing the risk factors will help you to make the changes to your lifestyle needed to help prevent Type 2 diabetes and other illness such as stroke or heart attack.
When we don't have enough insulin in the body to help us to use sugar from our food for energy the body starts to break down fat instead. Ketones are chemicals that build up as a result of the breakdown of fat and if this is left to build up it leads to a condition called ketoacidosis which is a serious medical emergency.
A sign of high ketone levels can be vomiting, dehydration, fast pulse, fast breathing, a distinct 'pear drops' smell on your breath (13). Ketoacidosis is more common in people with Type 1 diabetes.
Retinopathy or diabetic retinopathy is a disease that affects the blood vessels of the light sensitive layer at the back of the eye called the retina, causing them to bleed and leak, preventing light reaching it. High sugar levels over time damage the blood vessels and if left untreated it can lead to blindness.
Diabetic neuropathy is nerve damage that is caused by having a high blood sugar level. Over time this causes damage to the blood vessels that supply the nerves. It is one of the many problems that can occur with long term high blood sugar levels in diabetes (14).
There are 3 types of neuropathy;
- Sensory - which mainly affects the nerves of the feet and legs
- Autonomic - which mainly affects the organs eg.stomach, heart, bowels, bladder, sweat glands, sex organs
- Motor - which mainly affects the muscles and can lead to weakness and muscle wasting
Nerve damage cannot be cured but there is treatment to relieve the symptoms of pain. To reduce the risk of developing neuropathy it is vital to monitor blood sugar levels and keep them within an agreed target range. Keeping to a healthy diet and exercise plan will help to control your blood pressure. Attend your annual diabetes review to include an examination of your feet.
Diabetic nephropathy means that due to diabetes, your kidneys are not working as well as they should be. A protein called albumin, if found in small amounts in your urine without the presence of any other kidney disease is called microalbuminuria and is an early sign that your kidneys are not working as well as they should be (15). It is not normal to find traces of albumin in the urine so finding it early can give your doctor a chance to stop it getting worse. Your doctor has access to specific microalbuminuria tests which are far more sensitive than the dipstick type tests commonly used to diagnose a urine infection.
Good control of blood sugars and blood pressure, if it is high, is very important in helping to reduce the risk of developing diabetic nephropathy caused by damage to the blood vessels in the kidneys. It is a common complication of both type 1 and type 2 diabetes and can occur over time causing the kidneys to become unable to do its job of getting rid of the waste from the body. This can cause fluid to gather around your ankles, legs or arms. Medication or a special diet may be necessary and in some renal dialysis may be needed.
This is when your blood sugar is too high. The World Health Organisation define hyperglcemia as;
- A fasting blood sugar level greater than or equal to 7mmol/l
- A blood glucose level of 11mmol/l or greater 2 hours after eating (16)
Hyperglycemia can be caused by;
- Not taking your prescribed diabetes medication
- Eating too much carbohydrate
- Increased stress
- Feeling unwell,or having an infection
- Over treating a hypoglycaemic episode
Be aware of the signs of high blood sugar which can be;
- Increased thirst
- Increase in the need to pass urine
- Feeling dizzy
- Increased tiredness
Follow the advice given to you by your doctor or nurse.
You may need to have more insulin but you must always seek medical advice before doing this.
This is when your blood sugar is too low, and can lead to unconsciousness if not treated promptly and properly.
This can occur suddenly and some of the common symptoms are;
- Feeling shaky and weak
- Feeling sweaty
- Feeling hungry
- Feeling tired
- You can have mood swings and become angry
Always seek medical advice if your blood sugar remains low.