November is National Diabetes Month in the US, and many other countries around the world use the time to join together to raise awareness of this important condition that affects more than 4.9 million people in the UK. In addition, a staggering 13.6 million people are now at increased risk of developing type 2 diabetes, which can have severe complications if not treated properly. So almost a quarter of the UK population could be at risk, which is why we need to raise awareness of the problem more than ever.
What is diabetes?
Diabetes is a serious medical condition where a person’s blood glucose level is too high and is not adequately controlled by the body’s normal glucose control mechanism, which is insulin. In a healthy person, when blood glucose rises, the body produces insulin to remove it and bring it within normal levels. When a person has diabetes, then either the body doesn’t produce enough insulin, sometimes none at all, or the insulin that is produced is not effective at reducing the blood glucose, as is the case in insulin resistance.
Anyone can develop type 2 diabetes, although some ethnic groups have been identified as having a higher risk of diabetes. For example, type 2 diabetes is 2-4 times more likely in people of South Asian descent and African-Caribbean or Black African descent, and high blood pressure is also a common risk factor.
Types of diabetes
There are two main types of diabetes that most people are aware of. These are type 1 and type 2 diabetes. In type 1 diabetes, the body can’t make insulin at all or the insulin produced is destroyed by the immune system, and this is the type of diabetes that generally develops in younger people or rarely, those who are born with it. In type 2 diabetes, the body may produce some insulin, but maybe not enough, or its effectiveness wanes over time. This used to be called ‘late-onset diabetes’ because it is more common in older people.
There are other types of less well-known diabetes such as gestational diabetes, which some women can develop in pregnancy, and even rarer types such as type 3c and Latent Autoimmune Diabetes in Adults, (LADA).
In all these types of diabetes, glucose in the blood cannot be taken up by the cells properly so it continues to build up in the blood, which can lead to common symptoms of diabetes, which include:
- Needing the toilet more often, especially at night
- Feeling really thirsty
- Feeling more tired than usual
- Losing weight without trying to
- Genital itching or thrush
- Cuts and wounds which take longer to heal
- Blurred vision
How is diabetes diagnosed?
Diabetes is diagnosed through measuring the amount of glucose in the blood through an HbA1c blood test, which measures average blood sugar levels for the previous 2-3 months, but the results should be interpreted by a medical professional. Finger prick blood glucose test kits are available in pharmacies over the counter, but these type of tests only give a reading at a moment in time, so may show an elevated blood sugar level at the time of the test, which can be a warning, but there could be other reasons for this. You should always consult a medical professional for a conclusive diagnosis if you think you or a loved one is at risk of developing diabetes, and always if you have the symptoms of diabetes described above. The earlier that diabetes is detected, the more chance there is of avoiding complications such as blindness or amputations which can result in severe cases over time.
Is there a cure?
There is no cure for type 1 diabetes, and these people will need to have insulin injections throughout their life in order to manage their condition. Type 2 diabetes can often be managed by a change in lifestyle, particularly through diet and weight management programs, and many people successfully manage diabetes in this way. For others, where lifestyle and diet changes have not been effective, they may be prescribed drugs such as metformin or acarbose (Glucobay) or other drugs, and insulin injections in more severe cases.
Diabetes in children
The majority of children diagnosed with diabetes have type 1 diabetes, although children can develop type 2 diabetes and there are rarer forms such as monogenic diabetes, cystic fibrosis-related diabetes, and diabetes caused by rare syndromes as well as others.
In children, it is very important to diagnose diabetes quickly and symptoms can develop in days requiring urgent medical intervention. The symptoms to look out for in children are often called “the 4 Ts”, comprising:
- Toilet – where the child needs to pass urine more often, or there is bed wetting by a previously dry child, or heavier nappies for babies, or children who need to go to the toilet in the night
- Thirsty – when children are really thirsty and seem unable to quench their thirst
- Tired – when children feel more tired than normal or have less energy than would be expected of them
- Thinner – if children lose weight or begin to look thinner
If diabetes is not diagnosed or picked up, then there is a risk of the child suffering a hyperglycaemic episode (too high blood sugar) which can cause other medical complications. By contrast, if people have diabetes and are managing their condition with insulin, then there is also a risk of hypoglycaemia (blood sugar levels too low) which is a serious medical emergency which can lead to death if not treated properly.
Managing children with diabetes in a setting needs to be done with care, and all settings should have approved protocols for delivering medication to children if needed, which should be set up with the parents and other healthcare professionals.
It is important that all medication for such children (for example insulin injections) are stored at the correct temperature and are checked regularly to make sure they are in date. All staff who look after a child with diabetes should be trained in giving the specific medication, as well as knowing what symptoms to look out for in case of a hyper- or hypoglycaemic episode.
Remember too that exercise will affect blood glucose levels in most people, usually by lowering blood glucose, but certain types of high intensity exercise such as weight-lifting can actually increase levels, so it is important to understand each child and how they react through talking to parents and monitoring levels closely.
So, please take the time to raise awareness about diabetes in your setting this month, and make sure your procedures are updated regularly to help.