Complications
Short term complications
This section of the website considers three of the short term complications of diabetes – hypoglycaemia, diabetic ketoacidosis (DKA) and hyperosmolar non-ketotic acidosis (HONK). Not all of the short term complications are relevant to everyone with diabetes. If you are unsure about which may be relevant to you and your diabetes after reading this information, talk to your healthcare team for advice specific to your needs.
- Hyperosmolar non-ketotic acidosis (HONK)
Long term complications
This section of the website considers the long term complications of diabetes. By keeping blood glucose, blood pressure and cholesterol levels as near to normal as possible, together with following a healthy lifestyle you can help to improve well being and protect against long-term damage to the body such as the eyes, kidneys, nerves, heart and major arteries.
Treating Diabetes
Treating Diabetes
Although diabetes cannot be cured, it can be treated very successfully.
Type 1 diabetes is treated by insulin injections and a healthy diet, and regular exercise is recommended. Insulin cannot be taken by mouth because it is destroyed by the digestive juices in the stomach. People with this type of diabetes commonly take either two or four injections of insulin each day. If you have Type 1 diabetes, your insulin injections are vital to keep you alive and you must have them every day.
Type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity. Tablets and/or insulin may also be required to achieve normal blood glucose levels. There are several kinds of tablets for people with Type 2 diabetes. Some kinds help your pancreas to produce more insulin. Other kinds help your body to make better use of the insulin that your pancreas does produce. Another type of tablet slows down the speed at which the body absorbs glucose from the intestine. Your doctor will decide with you which kinds of tablet are going to work best for you and may prescribe more than one kind. Type 2 diabetes is progressive. If your diabetes cannot be controlled through lifestyle changes and tablets your doctor may recommend that you take insulin injections.
The main aim of treatment of both types of diabetes is to achieve blood glucose, blood pressure and cholesterol levels as near to normal as possible. This, together with a healthy lifestyle, will help to improve well-being and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.
Source: http://www.diabetes.org.uk/Guide-to-diabetes/What_is_diabetes/Treating_diabetes/
Causes and Risk Factors
Causes and Risk Factors
Type 1 diabetes
Type 1 diabetes develops when the insulin-producing cells in the pancreas have been destroyed. Nobody knows for sure why these cells have been damaged but the most likely cause is an abnormal reaction of the body to the cells. This may be triggered by a viral or other infection.
Type 2 diabetes
If you are white and over 40 years old, or if you’re black, Asian or from a minority ethnic group and over 25 years old and have one or more of the following risk factors, you should ask your GP for a test for diabetes.
The risk factors
• A close member of your family has Type 2 diabetes (parent or brother or sister).
• You’re overweight or if your waist is 31.5 inches or over for women; 35 inches or over for Asian men and 37 inches or over for white and black men.
• You have high blood pressure or you’ve had a heart attack or a stroke.
• You’re a woman with polycystic ovary syndrome and you are overweight.
• You’ve been told you have impaired glucose tolerance or impaired fasting glycaemia.
• If you’re a woman and you’ve had gestational diabetes.
• You have severe mental health problems.
The more risk factors that apply to you, the greater your risk of having diabetes.
Your age
You’re at risk of diabetes if you’re over 40 or you’re over 25 and black, Asian or from a minority ethnic group. The risk also rises with age so the older you get the more at risk you are.
The family
Having diabetes in the family puts you at risk. The closer the relative is, the greater the risk. So if your mum or dad has diabetes, rather than your aunt or uncle, it’s more likely you will develop the condition too.
Ethnicity
African-Caribbean or South Asian people who live in the UK are at least five times more likely to have diabetes than the white population.
Your weight
Not all people with diabetes are over weight but the stats show that over 80 per cent of people diagnosed with Type 2 diabetes are overweight. The more overweight and the more inactive you are the greater your risk. If you don’t know whether you’re overweight, ask your GP to measure your BMI.
Your waist
Women – if your waist measures 31.5in (80cm) or more you’ve got an increased risk.
Men – if you’re white or black and your waist is 37in (94cm) or more you have an increased risk of developing diabetes; if you’re an Asian man the figure is 35in (90cm) or more.
The other factors
If you’ve been diagnosed with any problems with your circulation, had a heart attack or stroke, or if you’ve got high blood pressure you may be at an increased risk of diabetes.
Pregnant women can develop a temporary type of diabetes – gestational diabetes. Having this – or giving birth to a large baby – can increase the risk of a woman going on to develop diabetes in the future.
Women with polycystic ovary syndrome who are overweight are at an increased risk of developing diabetes.
If you’ve been told you have either impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT) it means the level of glucose (sugar) in your blood is higher than normal but you don’t have diabetes and you should follow a healthy diet, lose weight if you need to and keep active, to help yourself prevent diabetes. But make sure you’re regularly tested for diabetes.
Other conditions such as raised triglycerides (a type of blood fat) and severe mental health problems can also increase your risk.
Source: http://www.diabetes.org.uk/Guide-to-diabetes/What_is_diabetes/Causes_and_Risk_Factors/Diabetes Symptoms
Diabetes Symptoms
The signs and symptoms of diabetes are:
• Increased thirst
• Going to the loo (for a wee) all the time – especially at night
• Extreme tiredness
• Weight loss
• Blurred vision
• Genital itching or regular episodes of thrush
• Slow healing of wounds
In Type 1 diabetes the signs and symptoms will usually be very obvious, developing quickly, usually over a few weeks.
In people with Type 2 diabetes the signs and symptoms will not be so obvious or even non-existent in people with Type 2 diabetes. If you’re older you may put the symptoms down to ‘getting on a bit’. Taking early action is key so if any of the symptoms apply to you, ask your GP for a diabetes test.
In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems.
Source: http://www.diabetes.org.uk/Guide-to-diabetes/What_is_diabetes/Signs_and_symptoms/Type 2 Diabetes in Children
Type 2 diabetes in Children
Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly. The hormone insulin is needed to allow glucose to pass into the body cells to provide energy. Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chappattis, yams and plantain, from sugar and other sweet foods. Glucose is also stored and released from the liver. Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).
Those at risk of developing Type 2 diabetes include:
* Caucasian people aged over 40 or over 25 if Black African Caribbean or South Asian.
* People who are overweight or obese.
* People who have a sedentary lifestyle.
* People with a first degree family history of diabetes (mother, father or sibling)
In 2002 The National Diabetes Audit (1) identified 102 children with Type 2 diabetes in the UK, an increase of 36 per cent from the previous year. The children were mainly from black and minority ethnic (BME) groups and this number continues to rise and spread through all communities and all backgrounds as children become less active and more overweight.
In October 2004 a Diabetes UK report Diabetes in the UK estimated that the number of children with Type 2 diabetes in the UK could be as high as 1,400 (2). This estimate was based on a survey of the number of overweight and obese schoolchildren in the UK.
Once the diagnosis has been made, the child should be referred to a paediatric specialist diabetes team including a registered dietitian so that close monitoring and support is available to give help to make the necessary changes in lifestyle. A positive attitude to this is necessary, as the child’s weight problems may not have been recognised within the family, especially if other family members are overweight.
Important points to remember include:
* The whole family must be involved in the necessary lifestyle changes.
* The child’s level of physical activity should be increased to one hour per day (3)
* A healthy eating plan is necessary to achieve weight control and good blood glucose levels
* Medication to help achieve good blood glucose control may be used. This is usually a tablet called Metformin. It works by reducing the amount of glucose produced by the liver and by making it easier for the muscle cells to accept insulin. Because of the way it works, it doesn’t lower the blood glucose enough to cause hypoglycaemia. It can help in weight loss with changes to healthy eating. Sometimes when this medicine is first taken it may cause stomach upset, but starting on a low dose, which is increased gradually, and taking the tablets with food can avoid this.
* Your healthcare team will test your child’s blood regularly to check that the kidneys are not affected by the medication. It is very important to continue the treatment as raised blood glucose levels are known to cause complications that may seriously affect the eyes, kidneys and later the heart, nerves and legs and feet.
The importance of preventing Type 2 diabetes in children cannot be overstated, as this is a progressive, lifelong condition that can lead to serious complications.
Effective prevention:
* Keep your child’s weight at the right level for their height. The ‘centile’ lines can be found in your child’s health record book and your family doctor or health visitor will be able to explain what these are.
* Try to encourage active hobbies as well as ones that do not involve physical exertion. These are even more enjoyable if the family joins in, so think about going out for a walk together, going swimming or for a bike ride.
* If you are concerned about your child’s risk of developing diabetes you should ask your GP, health visitor or school nurse for further advice and support.
We understand that the International Society for Paediatric and Adolescent Diabetes (ISPAD) is currently preparing guidelines for the management of Type 2 diabetes in children and we hope to be able to link to these when they are published.
References:
1 Diabetes UK in collaboration with Royal College of Nursing, Royal College of Paediatrics and Child Health & British Society for Paediatric Endocrinology and Diabetes (2004) The National Paediatric Diabetes Audit: Results from the audit year 2002 London: Diabetes UK
2 Lobstein T & Leach R (2004) Diabetes may be undetected in many children in the UK British Medical Journal 328: 1261-1262 (22 May)
3 Department of Health (2004) At least five a week: Evidence on the impact the impact of physical activity and its relationship to health London: Department of Health
Source: http://www.diabetes.org.uk/Guide-to-diabetes/What_is_diabetes/What_is_diabetes/Type_2_diabetes_in_children/
