Introduction to diabetes
Approximately 1.4 million people in the UK have diabetes and it is suggested by Diabetes UK that there could be another one million people with diabetes and are unaware they have it. The majority of people with diabetes (85% - 90% will have Type 2 diabetes). The remainder will have Type 1 diabetes.
Diabetes Mellitus is a condition in which the amount of sugar in the blood is too high. When we eat a meal the starchy and sugary carbohydrates are changed into sugar (glucose ) during dijestion and this sugar then passes into the bloodstream. When the pancreas senses that there is a rising level of glucose in the blood it secretes a hormone called insulin. Insulin changes glucose into energy which provides fuel for the body. Insulin is vital for life because without it, the glucose could not be changed into energy and the body could not function without energy. It is often said that insulin acts like a key – unlocking the cell to allow the energy in. Obviously, like a car, we only need a certain amount of energy to provide for the requirements of the body. If we eat more than we need this will be stored as fat.
Signs and symptoms of diabetes
· Excessive thirst
· Frequency in passing of urine
· Blurred vision
· Loss of weight
· Mood changes
· Frequent infections e. boils, thrush etc
Types of diabetes
There are two main types of diabetes:
· Type 1 ( used to be called insulin dependent ) affecting children and young adults mostly
· Type 2 diabetes ( used to be called non insulin dependent ) is commoner in the over 40 year olds although children as young as sixteen and obese are alsodeveloping Type2 diabetes
Main Aim of treatment
The main aim of treatment of both types of diabetes is to normalise blood glucose levels to protect against long term damage to the eyes, kidneys, nerves,
heart and all the blood vessels. Some experts call diabetes “a blood vessel disease” because preventing narrowing of the blood vessels is key to preventing complications.
Type 1 diabetes
The exact cause of Type 1 diabetes is unknown but thought to be due to a viral infection or environmental factors. In type 1 diabetes there is total destruction of the cells in the pancreas ( beta cells ) that produce the insulin. The onset of type1 diabetes is acute, because as stated earlier insulin changes glucose into energy but in the absence of insulin, glucose builds up in the blood and is not turned into energy. In an effort to overcome the lack of fuel for the normal functioning of the body, fats and proteins are broken down instead. This is why
patients are often underweight at diagnosis.
Once treatment with insulin is started the patient will begin to feel better quickly and will regain the lost weight.
Treatment for type1 diabetes
People with Type 1 diabetes will need injections of insulin for the rest of their lives. Insulin is destroyed by the gastric juices so cannot be taken in tablet form.
People with Type1 diabetes will need a minimum of two injections daily and often more. They will also need to eat a healthy diet and take regular exercise and do regular self blood glucose testing
If you have been diagnosed with Type 1 diabetes please ask your health professional for the special section on “ Insulin Ttreatment” which will give you much more specific and detailed information.
Type 2 diabetes
Type 2 diabetes occurs when the pancreas secretes less insulin than normal or when the insulin secreted fails to work properly (called insulin resistance). People who are overweight are five times more likely to develop Type 2 diabetes and four out of five people with Type 2 diabetes are overweight. Excess weight increases your body’s own glucose production and thus your body’s need for insulin too. At the same time, this extra insulin increases fatty acids stores and further increases insulin resistance. It becomes a vicious circle.
Type 2 diabetes is particularly associated with central excess weight ( apple shaped rather than pear shaped). Health risks increase when waist circumference is greater than 37inches (94cms) in men and 31.5 inches (80cms ) in women. Reducing calorie intake if you are overweight will help your body use insulin better by reducing insulin resistance.
You will find a whole section of this book devoted to healthy eating, weight control and exercise.
Type 2diabetes has a gradual onset. You may not feel any symptoms beyond a little tiredness which is often mistakenly attributed to age and working hard. As Type2 diabetes progresses you may become aware of some of the signs already mentioned or you may be diagnosed whilst being investigated for something else. It is suggested by experts that most people have had Type2 diabetes for at least five years before diagnosis.
The following people are at an increased risk of developing Type2 diabetes:
- Family history of diabetes
- Asian or Afro-Caribean origin
- Women who have had gestational diabetes
- Obese people
- People who take little exercise
- Older age
- People on certain medications eg steroids, and some anti psychotic medications
Treatment for Type2 diabetes
People with Type2 diabetes will be encouraged to eat a healthy balanced diet and take regular exercise. They will be treated with diet only for the first three months after diagnosis (unless their blood glucose is very high and they are losing weight). If diet and exercise alone does not control your blood glucose levels you may also need to take tablets.
Diabetes and Driving in UK
Having diabetes does not mean that you cannot drive as long as you doctor says you are safe to do so – this is usually when your diabetes becomes stable and controlled. You will however have to plan in advance before getting behind the wheel of your car if you are on certain tablets for your diabetes and/or taking insulin.
You must by law inform the Driver and Vehicle Licensing Agency (DVLA) if
- Your diabetes is treated with tablets or insulin
- If your treatment changes from tablets to insulin or if insulin is added to the tablets
- If there are changes in your health or condition that may affect your ability to drive safely
- If you are applying for a licence for the first time, you must answer YES to the question about diabetes.
After you have written to the DVLA informing them of your insulin treatment, you will be sent a form (called “Diabetic 1”), asking for more information and for the name and address of your GP/ Hospital Doctor. You will be asked to sign a consent form allowing the DVLA to contact the doctor directly for more specific information on your diabetes control, eyesight and general fitness to drive.
This does not mean that you will be refused a licence – it just ensures safety for you and other drivers. Please answer all questions fully and honestly.
People Treated with Tablets
After you have informed the DVLA that you have diabetes, they will send you a letter explaining your responsibility to re-notify them if you start having insulin or have “hypos” (low blood sugar), or if you develop any of the complications of diabetes which could affect your ability to drive.
They will not normally ask you any other questions at this stage and you will normally expect to keep your “till to” licence.
Diet alone Treated patients
No restrictions on driving and do not need to inform DVLA.
- Long journeys need careful planning, allowing for regular stops if you are on specific tablets for diabetes and insulin.
- Test your blood sugar before driving and regularly during a long drive or if at work before you drive home at the end of the day or shift.
- ·Always carry quick acting glucose and slow release carbohydrate in the car at all times if you are on insulin or specific diabetes tablets.
- Always carry identification on your person and in the car stating your name, how your diabetes is treated and the name of your GP.