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MYdiabetes

MY

MYchoice

pathSupportive self management in type 2 diabetes

This initiative is supported by Bristol-MyersSquibb (BMS) and AstraZeneca (AZ).

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CONTENTS

Foreword

Getting started

What are my goals?

You and your healthcare team

About my diabetes

How am I feeling?

Why do I need treatment?

What do my diabetes tests mean?

How’s my lifestyle?

Using prescribed medicines effectively

Glossary

Resources

References

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Type 2 diabetes is a serious condition which affects about one in 12 adults in Europe. By improving their lifestyle and getting the best out of their medicines, many people are living well with their diabetes – and so can you.

My Diabetes, My Choice, My Path seeks to highlight to you the things which are known to prevent or reduce your risk of complications of type 2 diabetes and improve your general health and well-being.

It doesn’t have all the answers or make your decisions for you. But it can support you as you think about your diabetes, consider your goals, check out other sources of information and plan for the kind of life you want to live – beyond your diabetes.

I hope you find it helpful.

Finally, I have to thank the members of the Editorial Advisory Board who gave freely of their time, experience and enthusiasm for this project:

Dr Tim AnstissPhysician specialising in behavioural medicine, health and wellbeing improvement, motivational interviewing and workforce development

Professor Antonio CerielloProfessor at the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, President of the European Association for the Study of Diabetes (EASD) Study Group and Member of the Board of the International Diabetes Federation (IDF)

Ms Sue CradockHonorary Consultant Nurse formerly based in Portsmouth NHS Trust, UK, with special remit to devel-op patient self-management programmes in diabetes, and Education Consultant to the DESMOND programme

Ms Gwen HallDiabetes Specialist Nurse in Primary Care, Associate Clinical Teacher at Warwick Diabetes Care at the University of Warwick, UK, and Vice Chair of the Primary Care Diabetes Society

Dr Cathy LloydSenior Lecturer in Health and Social Care, The Open University, UK, and member of the EASD Psychological Aspects of Diabetes (PSAD) Study Group

Professor Stefano del PratoProfessor of Endocrinology and Metabolism, University of Pisa, Italy

Foreword by Professor Anthony Barnett

Professor Jiten VoraConsultant Physician and Endocrinologist, Royal Liverpool University Hospitals, UK

Professor Johan WensGeneral Practitioner, University of Antwerp, Dept. of Primary and Interdisciplinary Care Antwerp (PICA) - Belgium, and Chairman of Primary Care Diabetes Europe

With a special thank you to Anne-Marie Felton, co-Founder and current Chair of the Federation of European Nurses in Diabetes (FEND)

Professor Anthony Barnett, ChairProfessor of Medicine, Consultant Physician and Clinical Director of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, UK

Editorial support provided by Jenny Bryan

We are also very grateful to John Roberts from J.A.R Health Consultants and the Merseyside Diabetes Support Group for their time and help with this project

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Getting started My Diabetes, My Choice, My Path aims to guide you towards improved health and wellbeing – helping you set goals and explore options for staying healthy and living well with your diabetes. However, you are the person who is best placed to decide how much you feel ready and able to change.

To help you get started, why not ask yourself a few questions about how you are doing right now.

On a scale of 1 to 10 (1 being very poor and 10 being very good), how would you rate:

Your general health

Your diabetes control

Your feelings about living with diabetes?

Your ability to carry out everyday work, family or social activities?

In this guide, you will find a lot of easy-to-read information.

My diabetes How I feel about my diabetes My test results My lifestyle My medicines

What would you like to improve?

Lose weight Be more active Quit smoking Feel less anxious about my diabetes Achieve better blood glucose control Get fewer hypos Something else ….

To get some tips on how to set yourself goals for improving your diabetes, take a look at ‘What are my goals?’

You are not alone with your diabetes. In this guide, you can find out about working in partnership with your doctors and nurses and other specialists. See “You and your healthcare team”

To help you discuss your progress with your doctor or nurse, you can use the ‘How am I doing?’pages in this guide to record your progress since your last appointment. There’s also space to write down any questions you’d like to ask your doctor or nurse during your next appointment

To find out what support groups and other resources are available where you live, take a look at the Resources at the end of the guide

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What are my goals?Personal goals in life are important. They can give our lives direction, focus and a means to self monitor how we are doing. We all have goals – though we don’t all write them down or check them regularly.

Writing down goals for different areas of your life (health, family, home, finance, hobbies, friendship, skills etc), creating plans to achieve them, and checking progress towards them can make a big difference to your future health and wellbeing.

People with diabetes sometimes find it useful to set themselves goals, in partnership with their doctor or nurse. This helps them to be clear about what they want to change.

Areas in which people with diabetes sometimes set goals include:

1 Finding out more about diabetes

• What it is • How it’s treated • Why it’s so important to keep it under control

2 Changing your lifestyle

• Quitting smoking • Dietary changes • Being more active • Talking to your doctor/nurse/dietician about your lifestyle

3 Setting your targets

• Weight/Body Mass Index (BMI)/waist measurement • Blood glucose control • Blood pressure • Blood cholesterol • Physical activity / exercise

4 Getting the most from your medicines

• Are they working, so you can reach your targets for glucose, blood pressure and cholesterol? • Are you getting any unwanted effects? • Are you taking them on time or missing any doses? • Would you like your doctor/nurse to give you more help with your medicines?

5 Living well with your diabetes

• Emotional: how are you feeling about your diabetes? Do you need to discuss your feelings or concerns with your doctor/nurse? • Family: are you able to fit your dietary and other needs with those of your family? • Social: do you feel able to attend social functions and carry on with your usual social activities? • Work: do your working hours or the type of work you do make it difficult for you to manage your diabetes?

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Top tipsfor settinggoals!

Be realistic! Don’t make your goals too tough – or too easy. If they are too tough, you will soon feel like giving up. If they’re too easy, you won’t make the changes you need to improve your diabetes control.

How much are you willing to change? The more committed you are to making changes to your life, the more likely you are to succeed.

Set some short term goals that you can achieve in the next few days or weeks and some long term goals for the next few months or years.

Decide how to reward yourself ! Knowing there are rewards for reaching your goals will motivate you to achieve them. But don’t choose rewards that will undo all your good work!

My first goal is to lose some weight, but I can never stick to diets, and am getting stressed about where to start.

Katrine

I started with small steps, like leaving sugar off my cereal and butter off my bread at breakfast, and taking smaller portions of things. Before long, I’d lost 2kg, and that really motivated me to set new goals.

Maria

I’m really good at sticking to my goals when I’m on my own, but find it harder when I’m out with friends.

Alan

I was embarrassed about telling my friends what I was trying to do, but I realised that I needed their help if I was going to succeed. Once they understood how important it was to me to stop smoking, they were really supportive and tried really hard not to smoke when I was with them.

Carlos

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I write down the three most important things I want to ask, and make sure I ask them at the start of my appointment, as soon as my doctor asks me how I am.

Monica

There are always so many other people at the clinic, I don’t like to take up too much time, and often go home without asking something important.

Lisbeth

You and your healthcare team More and more people with long term health problems, such as diabetes, are working in partnership with their healthcare team to agree goals and decide the best way to self-manage their condition. At regular appointments, they discuss their progress with their doctor or nurse. They can then make changes to their treatment and goals if these are needed.

Some people have a Diabetes Care Plan which sets out how they are managing their diabetes. The Plan is different for each person as it takes account of their type of diabetes, their overall physical and emotional health and well-being, and the effects of their diabetes on their home, working and social life.

If your doctor or nurse suggests you have a Diabetes Care Plan, you can discuss what goes into it with them so it meets your needs as closely as possible. Your doctor and nurse know a lot about diabetes, but they won’t know you well enough to make decisions about what you can and can’t do. So your views are very important.

What is in a Diabetes Care Plan varies between different treatment centres and in different countries. But it is likely to have information about your diabetes, including your glucose (sugar) level, your blood pressure, your cholesterol, your weight or waist measurement and the medicines you are taking, and advice about what to do if you are feeling unwell.

It may also include questionnaires to check how you are feeling, physically and emotionally, space for you to write down questions you would like to ask at your next meeting with your doctor or nurse, and contact numbers for your diabetes care team in case you need to get in touch with them out of office hours.

Whether or not you have a Diabetes Care Plan, it’s helpful to prepare for each appointment with your doctor or nurse, so you get the most out of it, even when there doesn’t seem to be much time. The more clearly and concisely you can explain how you have been feeling, how well you have controlled your blood glucose (sugar) and how near you are to achieving your goals, the better your doctor or nurse can help you to self-manage your diabetes.

The “How am I doing?” form in the guide can help you record your progress and make a note of any questions you have. It’s always useful to take a friend or relative to your appointment so they can remind you of anything you have forgotten, and to help you remember any new information you are given.

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How am I doing?

On a scale of 1 to 10, how have you been feeling since your last appointment?

Since your last appointment, what has been going better? (tick boxes) Diet Physical activity Not smoking Blood glucose control Taking prescription medicines Other things? (please add)

Since your last appointment, what hasn’t been going so well? (tick boxes) Diet Physical activity Not smoking Blood glucose control Taking prescription medicines Other things? (please add)

What would you like to achieve from your next consultation?

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Questions you may want to ask your doctor or nurse

Diet and physical activityIf I b• ecome more active, do I need to adjust my diet and medication?Is my type 2 diabetes reversible? If I lose weight and change my lifestyle, will I be able to stop taking my • diabetes medicines?

Blood glucose control Ho• w often should I have my blood glucose levels, blood pressure and cholesterol tested? Would it help me to self-test my blood glucose levels?•

Diabetes medicinesWh• at happens and what should I do if I skip my treatment?I seem to be taking a lot of tablets – for my diabetes, blood pressure and glucose. Do I really need to take all • these tablets, or could I cut down on some of them?

Concerns about diabetesPeo• ple tell me that I’m more moody than I used to be, and that I get too angry when things aren’t going perfectly? Could this be due to my diabetes?

I’m worried about getting health insurance or losing my driving licence, now I have diabetes. How will my • diagnosis affect these things?

I’m feeling depressed because I never seem to reach my targets? What can I do? •

What should I do if I get influenza or other type of infection?•

What happens if I need to go to the dentist or to have surgery? •

Now that I have diabetes, should I advise my brother/sister/other relatives to have their blood glucose tested?•

Who is in your diabetes team?

Doctor with a special interest/training in diabetes•

Nurse with a special training in diabetes •

Dietician who can advise you about changing your diet to help your diabetes•

Podiatrist/chiropodist who advises you on foot care and treats problems which may arise•

Optometrist (optician) or hospital specialist trained in recognising diabetes eye disease•

Other specialists who might be involved in your care include those who have special expertise in the heart • (cardiologist), kidneys (nephrologist), circulation to the legs and feet (vascular surgeon), obstetrician (for pregnant women), mental health (psychologist or psychiatrist), diabetes trained healthcare provider (educator)

My father had a heart attack and died when he was only 55 – the same age as I am now. I’m really scared the same thing will happen to me.

Hans

I talked about my worries with my doctor and she explained all the improvements in healthcare that have happened since my Dad had his heart attack. By sticking to my targets and having regular check-ups, I feel more in control of my health, and know I am doing everything possible to avoid a heart attack.

Johan

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About my diabetes

What is type 2 diabetes? If you have type 2 diabetes, your body can’t control the amount of sugar (glucose) in your blood. This may be because you aren’t making enough of a hormone called insulin, or your body isn’t using the insulin you produce correctly, or both.

Insulin is made in your pancreas – a gland behind your stomach. Insulin helps glucose get into your muscle and other cells so you can turn it into energy. Some glucose comes from your food, and some is made in your liver. If you have too little insulin, or your body doesn’t use it correctly, glucose stays in your blood instead of going into your organs. So you have high glucose levels in your blood.

If you have type 2 diabetes, you may also have:

H• igh blood pressure – the force of blood flow through your arteries is high. This is usually because your arteries have become diseased, stiff and narrowed, so your blood has to push its way through, making your blood pressure rise

High cholesterol • – one of several fats (lipids) in your blood that come from your food or are made in your liver. Total cholesterol levels may rise because there is too much fat, especially saturated (animal) fat in your diet although inherited factors will also affect how much cholesterol is in your blood

Weight problems• – being overweight or obese, especially having a big waist (also called abdominal obesity) – are common with diabetes, and are affecting more and more people

Who gets types 2 diabetes?

You are more likely to get type 2 diabetes if:

A• parent, brother, sister or other close member of your family has type 2 diabetes You are overweight or have a big waist• Your family came from South Asia, Africa or the Caribbean• You have high blood pressure or you’ve had a heart attack or a stroke • You have ‘pre-diabetes’ – your blood glucose levels are slightly raised, but not • high enough for the diagnosis of diabetes Some other names you may hear for pre-diabetes include:

Borderline diabetes• Impaired glucose tolerance [IGT]• Impaired fasting glucose (IFG)•

You• had diabetes while you were pregnant (called gestational diabetes), you had a baby weighing more than four kg at birth

You have abnormal levels of certain types of cholesterol•

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How am I feeling?

When you are first diagnosed with type 2 diabetes, you may not have any physical symptoms. But it is important to be able to recognise symptoms that may mean your diabetes is not well controlled.

Physical symptoms of poor diabetes controlIf your type 2 diabetes is not well controlled and your blood glucose is raised, you may;

Be more thirsty than usual• Need to pass urine more often, especially at night• Feel very tired• Have blurred vision• Get dry, itchy skin• Have wounds that heal slowly• Feel tingling in your hands and feet• Get frequent or recurring infections• Suffer from “thrush” if you are a woman•

My emotionsFinding out that you have type 2 diabetes can be a shock. It’s normal to feel worried or upset, and to ask “why me?” You may feel angry that your body is letting you down or confused about what is happening to you. These feelings often subside as you become used to having diabetes, but it’s easy for such emotions to affect other parts of your life. You may find it hard to concentrate at work, or feel impatient with people, even when they are trying to help. You may find yourself avoiding social events because you don’t want to talk about your diabetes, or feel embarrassed about it.

There’s no right or wrong way to deal with how you feel about your diabetes. Feeling depressed or anxious is very common in people with type 2 diabetes so you are not alone. The good news is that there are things you can do to get your mood and feelings back to normal, to become less anxious and depressed.

It’s important that you get help and support if you are feeling depressed because strong emotions can impact on your blood glucose levels as well as reduce your quality of life. Some people find it helpful to talk about their diabetes with friends and family, their doctor or nurse. Learning more about your diabetes and how it can be treated effectively may help you feel less anxious and more in control of your body and your life. Don’t expect to take everything in at once, and try not to feel embarrassed about asking questions until you have all the information you need. Take it one step at a time, at your own pace.

But if you feel that your emotions are making you unwell and preventing you from coping with your diabetes, your doctor or nurse should be able to help you or refer you to a counsellor, psychologist or someone who is trained to help you deal with emotions. ‘Talking therapies’ have been shown to be effective in reducing symptoms of depression or anxiety and supporting people to manage their diabetes effectively.

Could I be depressed?

Ask yourself the following questions. If the answer to either of them is “yes”, your doctor, counsellor or other trained therapist may be able to help you find out what is making you depressed and how you can deal with it.

During t• he last month, have you often been bothered by feeling down, depressed or hopeless?

During the• last month, have you often been bothered by having little interest or pleasure in doing things?

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Why do I need treatment? Too much glucose in your blood can damage your blood vessels, particularly those supplying your heart, brain, legs, kidneys, eyes and nerves. For some people – though not everyone – this can lead, over time, to serious complications of diabetes, including:

Skin infections• Vaginal discharge or dryness• Loss of or abnormal sensation in the feet• Blurred vision• Foot ulceration• Erectile dysfunction• Kidney failure• Angina and heart attacks• Strokes• Blindness• Amputation of limbs•

Taking control of your type 2 diabetes and getting your blood glucose level as near to normal as possible will reduce your risk of diabetes complications. As you may have had too much glucose in your blood for months or even years before you were diagnosed with type 2 diabetes, the first stages of complications may already have started, such as hardening of the arteries, diabetes-related kidney and eye disease and nerve degeneration. You may not be aware of these problems in the early stages as you probably don’t feel ill, but you can reduce the risk of them getting worse.

This is why it’s so important to take your diabetes seriously – right from the start. The results of some of your tests may help you see the changes that are already happening to your body, and show you why you need to get your glucose, blood pressure, cholesterol levels, and body weight as close to normal as you can, and stop smoking.

I have been so depressed since being diagnosed with diabetes, my whole life seems to revolve around my blood glucose.

Anders

I’ve been amazed how much a daily walk has lifted my spirits. I walk along the canal near my work for 20 minutes each day, with the phone off and no one to bother me. When I get back, I’m in a much better mood than everyone else in the office, and I know that exercise is good for my diabetes as well!

Karl

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What do my diabetes tests mean? If you have type 2 diabetes, you won’t just have tests for the amount of glucose in your blood. You should also be offered tests to measure your blood pressure, cholesterol and other fats in your blood, and your kidney function. Your feet and legs should be checked for corns, calluses or signs of poor circulation, and your eyes should be checked for damage to blood vessels in the retina – the ‘seeing’ part of the eye.

Together, your glucose, fats and blood pressure can affect your risk of complications, such as heart attacks and strokes. Smoking, being overweight, eating an unhealthy diet and being inactive can also add to these risks.

Treating all these factors to agreed targets can reduce your risk of complications.

Measuring glucoseThe amount of glucose in your blood can be measured in several different ways:

Fasting glucose• is measured when you haven’t eaten anything for several hours (usually first thing in the morning). So the glucose level should be at its lowest

Random glucose• is measured at any time of day, so it’s usually higher than when you haven’t eaten anything for several hours

Oral glucose tolerance test • measures the amount of glucose in your blood after you have had a drink of 75g of glucose. It shows how well your body is responding to sugar in your diet

Post prandial glucose test • measures the amount of glucose in your blood two hours after a meal. Blood glucose levels usually rise when you eat and return to normal within two hours. If your level remains high, it shows that you do not have enough control over your blood glucose. Post prandial glucose tests are mainly done to aid the diagnosis of diabetes, but may also be done to monitor whether medicines are working

HbA1c• tells you how much glucose you have typically had in your blood over the past two to three months. It measures the amount of glucose that is being carried by your red blood cells on a day to day basis

The first three tests on this list are often used to diagnose diabetes, while HbA1c can show how well you are controlling your diabetes over a period of time. In the future, it may also be used to diagnose diabetes.

Some people test their glucose regularly during the day when they are at home or travelling around. This gives them more information about their day to day control of blood glucose, and can be used as part of a structured Diabetes Care Plan drawn up with their diabetes care team.

Regular blood glucose measurements are most often done by people who are using insulin to control their diabetes, as they need to check what dose of insulin they need. However, people using other types of diabetes medicines may also benefit from regular blood glucose measurements.

Self-testing is also helpful to ensure that your glucose levels are well controlled and to prevent your glucose counts from dropping too low (called hypoglycaemia), or for other reasons. Your doctor or nurse can help you decide if self-testing would be helpful for you.

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Measuring cholesterolYour cholesterol can be measured in several different ways, and the results you are given will depend on your local healthcare system.

Tot• al cholesterol is the simplest measurement of how much cholesterol you have in your blood, and is the number you are most likely to be given

LDL-cholesterol• measures the amount of the more harmful type of cholesterol that can build up in the walls of your arteries and make them narrower or help to block them

HDL-cholesterol• is often called ‘good cholesterol’ as it helps to get cholesterol out of your blood and away from your arteries

Triglycerides• are another type of fat in the bloodstream, high levels of which are harmful and can cause arterial disease

Measuring blood pressure Your blood pressure is measured as systolic blood pressure and diastolic blood pressure:

Systo• lic pressure is the blood pressure in your arteries when your heart beats and pushes blood around your body

Diastolic pressure• is the blood pressure in your arteries when your heart relaxes, between beats

Your systolic blood pressure is always higher than your diastolic blood pressure. When the two measurements are written down, the systolic reading always comes before the diastolic reading. Both are measured in units of millimetres of mercury (mm Hg), for example 130/80 mm Hg.

Measuring kidney functionAs kidney disease is more common in people with diabetes, you will be offered tests to check how well your kidneys are filtering and cleaning your blood. These include tests for:

Prot• ein in your urine – this can be used to make sure that your kidneys aren’t leaking protein into your urine as well as waste products

Creatinine in your blood• – this can be used to measure kidney function and also to estimate how well your kidneys are filtering your blood (estimated glomerular filtration rate, eGFR)

A simplified way of assessing kidney function is called the albumin to creatinine ratio which is usually calculated from tests on an early morning urine specimen.

Checking your feetToo much glucose in your blood can damage the nerves in your legs and feet. This is called diabetic neuropathy. Nerve damage may affect the way you feel heat, cold or pain in your feet, so you may injure your foot without realising it. Nerve damage may also affect your movement and the way you walk, and it can stop the sweat glands in your feet from working properly, so your skin gets dry and cracked. If your circulation is also poor, this can make it worse.

By checking your feet every day for any signs of scratches or scrapes, you can make sure that any small injuries are treated quickly so they don’t become more serious. Don’t forget to check between your toes too.

You should also see a foot specialist, called a podiatrist or chiropodist, at least once a year to make sure that there is no damage to your feet.

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What's my target? After a lot of research, European experts have agreed a set of targets for glucose, blood pressure and cholesterol for people with diabetes. They are in the chart below. But it may not be possible for everyone to reach these targets straight away. If you discuss your test results with your doctor or diabetes nurse, you can decide what targets you can aim for over the next few months, and in the future.

Recommended target Your current target by …….

Fasting glucose Under 6 mmol/l / 110 mg/dl

Post-meal glucose Under 7.5 mmol/ 135 m/dl

HbA1c 6.5% to 7.5% (48-58 mmol/mol)

Total cholesterol 4 mmol/l (155 mg/dl) or less

LDL-cholesterol 2 mmol/l (80mg/dl) or less

Blood pressure 130/80 mm Hg

Waist measurement European Men: less than 94 cm (37 in) Women: less than 80 cm (31.5 in)

South Asian and Chinese Men: less than 90 cm (35.5 in) Women: less than 80 cm (31.5 in)

Target HbA-1c depends on a whole range of factors. UK guidelines recommend that for those more recently diagnosed on a maximum of two oral medicines for diabetes the target is 6.5%. For those on more than two medicines for diabetes and particularly if they are on insulin, the guidelines recommend a target of 7.5%. HbA1c targets should be discussed with your doctor and/or nurse, and agreed with you based on your personal circumstances and your general health.

I’m frightened that my diabetes will make me go blind.

Nicola

My aunt is in her 60s and has had diabetes for many years. She has good eye sight and puts it down to careful control of her blood glucose and regular eye checks.

Milana

Checking your eyesKeeping your blood glucose and blood pressure under control will help to prevent damage to important blood vessels to the retina at the back of each eye. The retina is the ‘seeing’ part of the eye, which records what you are looking at before sending the images to your brain. Damage to your retina, called diabetic retinopathy, can affect your vision so you cannot see so well.

Your eyes should be checked for any signs of damaged blood vessels at least once a year, and you should be sure to tell your doctor or diabetes nurse if you notice any change in your vision.

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Did you know?Reducing your total cholesterol by 10% will lower your risk of getting heart disease in the next five years by a quarter (25%). If you lower your HbA1C (your three month average blood glucose level) by 1% you can reduce your risk of dying from diabetes-related complications by over one fifth (21%).

Good control of glucose, blood pressure and cholesterol can reduce your risk of getting diabetes complications by:

As much as three quarters (76%) for eye disease•

Up to half (50%) for kidney disease•

Over half (60%) for nerve disease•

One third (33%) for strokes •

What to expect: Diabetes tests and checks when you see your doctor or nurse

1. Your blood glucose – HbA1c, fasting or random blood glucose

2. Your blood pressure – recorded as systolic and diastolic pressure

3. Your weight/waist measurement – how close you are to your target

4. Smoking – your progress with quitting

5. Your medicine taking – successes and problems

6. Your cholesterol – including total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides

7. Your kidneys – including tests of kidney function such as serum creatinine level and glomerular filtration rate

8. Your feet and legs – corns, calluses and nail problems, ulcers, circulation and reflexes

9. Your eyes – examination of blood vessels at the back of the eyes usually by photography

10. Anything different or new from the previous visit

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How's my lifestyle? Quitting smoking, eating healthily and being active can have bigger benefits for your type 2 diabetes than you would think. In fact, they’re good for your whole body and well-being and for your family too.

By making some simple changes to your lifestyle now, you can improve your health for years ahead. You won’t need to give up all your favourite foods or start running marathons, just take more care what you put in your shopping basket, and make your day a little more active.

Did you know?If you quit smoking …..

Eight hour• s later, your circulation will start to improveThree to nine months later,• coughs, wheezing and breathing problems will start to improveOne year later,• your risk of a heart attack will be half that of someone who smokes

How do you measure up?Your body mass index (BMI) can tell you if you are a healthy weight for your height. Ideally, your BMI should be 18.5-25 kg/m2. If your BMI is over 25 kg/m2, losing some weight would be good for your diabetes and your health, especially if your BMI is 30 kg/m2 or over. Achieving a BMI of 25 kg/m can be difficult, especially if your BMI is over 30 kg/m2. As a first step, reducing your body weight by 5-10% can be good for your diabetes and your health.

You can calculate your BMI yourself. Take your weight in kilograms (kg) and divide it by your height in metres (m). Then divide the result by your height in metres (m) again.

Or you can use this chart:

Weight in Kilograms

45 48 50 53 55 58 60 63 65 68 70 73 75 78 80 82.5 85 87.5 90

145.0 21.4 22.6 23.8 25.0 26.2 27.3 28.5 29.7 30.9 32.1 33.3 34.5 35.7 36.9 38.0 39.2 40.5 41.6 42.8

147.5 20.7 21.8 23.0 24.1 25.3 26.4 27.6 28.7 29.9 31.0 32.2 33.3 34.5 33.6 36.8 37.9 39.1 40.2 41.4

150.0 20.0 21.1 22.2 23.3 24.4 25.6 26.7 27.8 28.9 30.0 31.1 32.2 33.3 34.4 35.6 36.7 37.8 38.9 40.0

152.5 19.3 20.4 21.5 22.6 23.6 24.7 25.8 26.9 27.9 29.0 30.1 31.2 32.2 33.3 34.4 35.5 36.5 37.6 38.7

155.0 18.7 19.8 20.8 21.9 22.9 23.9 25.0 26.1 27.1 28.1 29.1 30.2 31.2 32.3 33.3 34.3 35.4 36.4 37.5

157.5 18.1 19.1 20.5 21.2 22.2 23.2 24.2 25.2 26.2 27.2 28.2 29.2 30.2 31.2 32.2 33.3 34.3 35.3 36.3

160.0 17.6 18.6 19.5 20.5 21.5 22.5 23.4 24.4 25.4 26.4 27.3 28.3 29.3 30.3 31.3 32.2 33.2 34.2 35.2

162.5 17.0 18.0 18.9 19.9 20.8 21.8 22.7 23.7 24.6 25.6 26.5 27.5 28.4 29.3 30.3 31.2 32.2 33.1 34.1

165.0 16.5 17.4 18.4 19.3 20.2 21.1 22.0 23.0 23.9 24.8 25.7 26.6 27.5 28.5 29.4 30.3 31.2 32.1 33.1

167.5 16.0 16.9 17.8 18.7 19.6 20.5 21.4 22.3 23.2 24.1 24.9 25.8 26.7 27.6 28.5 29.4 30.3 31.2 32.1

170.0 15.6 16.4 17.3 18.2 19.0 19.9 20.8 21.6 22.5 23.4 24.2 25.1 26.0 26.8 27.7 28.5 29.4 30.3 31.1

172.5 15.1 16.0 16.8 17.6 18.5 19.3 20.2 21.0 21.8 22.7 23.5 24.4 25.2 26.0 26.9 27.7 28.6 29.4 30.2

175.0 14.7 15.5 16.3 17.1 18.0 18.8 19.6 20.4 21.2 22.0 22.9 23.7 24.5 25.3 26.1 26.9 27.8 28.6 29.4

177.5 14.3 15.1 15.9 16.7 17.5 18.3 19.0 19.8 20.6 21.4 22.2 23.0 23.8 24.6 25.4 26.2 27.0 27.8 28.6

180.0 13.9 14.7 15.4 16.2 17.0 17.7 18.5 19.3 20.1 20.8 21.6 22.4 23.1 23.9 24.7 25.5 26.2 27.0 27.8

182.5 13.5 14.3 15.0 15.8 16.5 17.3 18.0 18.8 19.5 20.3 21.0 21.8 22.5 23.3 24.0 24.8 25.5 26.3 27.0

185.0 13.1 13.9 14.6 15.3 16.1 16.8 17.5 18.3 19.0 19.7 20.5 21.2 21.9 22.6 23.4 24.1 24.8 25.6 26.3

187.5 12.8 13.5 14.2 14.9 15.6 16.4 17.1 17.8 18.5 19.2 19.9 20.6 21.3 22.0 22.8 23.5 24.2 24.9 25.6

190.0 12.5 13.2 13.9 14.5 15.2 12.5 16.6 17.3 18.0 18.7 19.4 20.1 20.8 21.5 22.2 22.9 23.5 24.2 24.9

Underweight Normal Overweight Obese

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Your waist measurement is also a good guide to whether you are a healthy size. Men and women with large waists are more likely to have heart attacks and strokes than those with smaller waists. If you are a man with a waist over 102 cm or a woman with a waist over 88 cm, losing some weight would be good for your diabetes and your health.

Measuring your waist isn't quiteas easy as you might think!

Put the tape measure around your waist at the narrowest point between the bottom of your ribs and • the top of your hip bone. If you can’t decide where this is, lean to one side and see where your skin creases. This is where to measure your waist

Make sure the tape is straight and snug but doesn’t pull your flesh in•

Measure after breathing out•

Top tips for healthy eating

To help you lose or manage your weight, eat three meals a day. 1. Skipping a meal won’t reduce how much you eat because you’ll just eat more at other meals because you’re so hungry, or snack between meals.

We all need some carbohydrate at each meal but,2. as you have diabetes, choose starchy carbs, such as pasta, grainy bread, rice or potatoes, not sugary carbohydrates, such as cakes and biscuits.

Aim for at least five portions of fruit and vegetables each day. 3. You can include unsweetened fruit juices and smoothies.

To help you lose weight, reduce the total amount of fat in your diet. 4. Choose low fat dairy products, such as skimmed or semi-skimmed milk, and eat less butter and cheese. Try lean meat and fish, and steam, grill or bake, rather than fry.

To provide omega-3 in your diet,5. include two portions of oily fish, such as salmon, mackerel or sardines, in your weekly shop.

If you want to reduce your weight, check your alcohol intake.6. Alcohol contains many calories and they are easily taken in! Healthy drinking is no more than two units per day for women, and three for men. Remember that the alcohol content of many drinks is higher than it used to be. Half a pint of beer/lager has 1-1.5 units, and a small glass of wine (175ml) can have two units.

Sweet, fizzy drinks will put your blood glucose7. up very quickly so may be best avoided. But make sure you drink plenty of liquid (eg: water or diet drinks).

Don’t have too much salt in your diet8. – less than a teaspoonful per day (under 6 grams).

Forget miracle diets.9. For the best advice, talk to your dietitian.

Over to you ...

Why might you want to eat more healthily?1.

What are your three best reasons for doing it?2.

How would you go about it, if you did decide to eat more healthily?3.

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Small changes, big effects!

Slice 85-90 calories out of your daily total by ….Leaving butter or margarine out of your sandwich or not having the bread roll you have with your soup• Eating your salad without mayonnaise or other dressing • Taking the packet of crisps out of your lunch box• Eating half a small chapatti less with your dinner• Drinking your tea or coffee with two teaspoons less sugar or honey•

If you like Indian food: • Choose tandoori or madras with chicken, prawns or vegetables, instead of creamy korma, passanda or massala• Ask for plain rice and chapatti instead of pilau rice and naan

If you like Chinese food: • Try steamed fish, chicken chop suey, szechwan prawns, boiled rice• Try to avoid prawn crackers, dim sum, spring rolls and anything in batter

Check the labels

To check out the sugar content of your food, look for the “Carbohydrates (of which sugars)” figure on the • label. A high level is 15g sugars per 100g, while a low level is 5g sugars or less per 100g

If the total fat on the label is over 20g per 100g, or the saturated fat content is over 5g per 100g that’s high. • Check out alternatives with less fat

Low fat options have 3g of total fat per 100g or less, and saturated fat of 1.5 g per 100g or less •

If the salt content is over 1.5g salt per 100g (or 0.6g sodium), this is high. Try to find lower salt alternatives. • A low salt content is 0.3g with per 100g (0.1g sodium) or less

Life without sweets and chocolate is so miserable.

Ilse

I haven’t given them up completely, but I try to make a bar of chocolate or a bag of sweets last the whole week. Sometimes I have a bad day and eat the lot, but I don’t beat myself up about it. I just try not to let it happen again.

Cathy

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Get active

Q How active do I need to be to help my diabetes?

A. The recommended minimum for adults is 30 minutes brisk walk or equivalent on at least five days per week. For children, it’s one hour a day. You don’t need to do it all at once. You may find it easier to be active for 10 minutes at a time.

Q What counts as ‘being active’?

A. You don’t have to go to the gym. Walking or cycling to the shops or to work, instead of taking the bus or car. Taking the stairs instead of the elevator or escalator. Playing football with the family, swimming, cycling or dancing. Digging or weeding in the garden, or mowing the lawn. All of these everyday activities count as ‘being active’, as is a brisk walk for 30 minutes which is enough to make you warm, increase your heart rate and make you breathe slightly more heavily than normal. You should be able to hold a conversation with someone, but perhaps not to sing! This is called ‘moderate-intensity activity’ and it has been shown to be very beneficial to people with and without health problems.

Q If I have short spurts of activity, how will I know if I’m doing enough? A. Try sticking a chart on your wall, and record each time you are active in a way that you weren’t before. You’ll be pleased to see how all your brief busts of activity add up. Very satisfying!

Over to you ...

Why might you want to become more active?1.

What are your three best reasons for adopting a more active lifestyle?2.

How would you go about it, if you decided to become more active?3.

Exercise has never been my thing, I don’t know where to start.

David

I started with using the stairs on the way to work, instead of the elevator, and getting off the bus one stop early. After a while I rather enjoyed the extra walk, as I felt more awake when I got to work.

Robert

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Using prescribed medicines effectively

Like many other people with diabetes, you may be tempted not to take your diabetes medicines as prescribed. The main reasons why people do not take their medicines appear to be:

They don’t believe they are making a difference to their health•

They believe that they will do them more harm than good•

They want to keep control of their own bodies•

How do these statements apply to you?

If you understand your diabetes medicines, you can take them more effectively, with as few unwanted effects as possible. The same is true of medicines you are taking to control your blood pressure or cholesterol.

All medicines work best if you take them in the recommended dose, at the recommended times. If you miss doses of your diabetes medication, there won’t be enough medicine in your bloodstream to keep your glucose at your target level.

Keeping your glucose under control is important, whether you have just been diagnosed with type 2 diabetes or have had it for many years. You won’t feel any different if you forget to take you medicine because your body doesn’t ring an alarm bell. But every day that your glucose is too high increases your risk of getting complications.

There are several different types of diabetes medicine, and talking about them with your doctor or nurse will help to decide which type is best for you.

Diabetes treatmentSome of the more commonly used groups of drugs for diabetes are listed in the following table. Within each group there may be several different drugs, whose names vary depending which country you live in. Your doctor or nurse can explain which group your drug fits into.

Many people with diabetes need more than one medicine to control their blood glucose, so it is useful to get a better understanding of how the different drugs work with one another and what what side effects they may have. In this table, we have written the general (or “generic”) names of the drugs. You will see these names, usually in smaller print, on the packaging of your medicine. But you may know your medicines better by their brand names. These are usually the bigger names on the packaging.

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Name of medicine

Why you may be getting this medicine How you take it What it does

Most common unwanted effects to talk to your doctor or nurse about

Metformin Used in patients who are overweight, long-term use of metformin alsohelps to lower the risk of any problems related to diabetes

The usual starting dose is one tablet two or three times a day. Your doctor will tell you when to take this

Works by improving the sensitivity of your body to insulin. It helps your body to use glucose in the normal way again

Stomach problems such as feeling sick (nausea), being sick (vomiting), diarrhoea, stomach pain and loss of appetiteThese side effects are most likely to happen at the start of treatment

Sulfonylureas, eg: gliclazide, glibenclamide (also called glyburide), glipizide, glimepiride

Used for the treatment of people with diabetes who do not need insulin but who need more than just diet to control their diabetes

Unless your doctor has instructed differently, these tablets should be taken once a day with breakfast or the main meal of the day

Works by increasing the amount of insulin released from your pancreas. The insulin then lowers your bloodsugar levels

Hypoglycaemia (low blood sugar levels)Stomach upsets, increased appetite and weight gain

Mealtime (prandial) glucose regulators, eg: repaglinide, nateglinide

Used to control type 2 diabetes as an add on to diet and exercise. Treatment is usually started if diet, exercise and weight reduction alone have not been able to control (or lower) your blood sugar

Taken immediately before or up to 30 minutes before each main meal

Works by stimulating the pancreas to produce insulin more quickly. This helps to keep the blood sugar controlled after meals

Hypoglycaemia, stomach pain and diarrhoea

Glitazones (in Europe only Pioglitazone canbe used)

May be used on its own or in combination with metformin and or a sulphonylurea which are also oral anti-diabetic medicines. May also be used in combination with insulin

You may take your tablets with or without food

Helps control the level of sugar in your blood when you have type 2 diabetes by helping your body make better use of the insulin it produces

Weight gain, respiratory infection, numbness and abnormal visionA higher risk of bone fractures in women

Gliptins also known as DPP4 inhibitors, eg: sitagliptin, vildagliptin, saxagliptin

Helps to improve the levels of insulin after a meal and lowers the amount of sugar made by your body

You may take your tablets with or without food

Works by making the pancreas produce more insulin and less glucagon. Glucagon is a substance which triggers the production of sugar by the liver, causing the blood sugar level to rise The pancreas makes both of these substances

Upper respiratory infections, diarrhoea, dizziness, low blood sugar when used with Sulfonylureas or insulin

Acarbose May be used to treat diabetes when a restricted diet alone or a restricted diet plus other sugar-lowering drugs do not work well enough

One or two tablets taken three times day with a meal

Works by slowing down the digestion of carbohydrates (complex sugars) which reduces the abnormally high blood sugar levels in your body after each meal

Wind (flatulence), diarrhoea, stomach or abdominal pain

Glucagon-like peptide analogues, eg: exenatide, liraglutide

May be used with other diabetic medicines called metformin, sulphonylureas or thiazolidinediones.

Should be injected at any time within the 60 minutes (one hour) before your morning and evening meals, or before your two main meals of the day, which should be about 6 hours or more apart

Helps your body to increase the production of insulin when your blood sugar is high

Nausea, vomiting and diarrhoea

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About hypos

Hypoglycaemia (also called ‘hypo’) means your blood glucose level has gone too low to give your body the energy it needs. This happens if your blood glucose level goes under about 4 mmol/l, and gets worse with lower glucose levels.

It can happen if you haven’t eaten enough or been very active, or you have had too much diabetes medicine (particularly sulfonylurea tablets or insulin) for your needs.

If you have a mild hypo, you may feel hungry, anxious or shaky, you may go pale, and your heart may beat fast, and your lips tingle. Your vision may become blurred. You can quickly give yourself some sugar by eating some sweets or glucose tablets, or having a glass of fruit juice. You should then have a snack, such as half a sandwich, a small bowl of cereal, or biscuits and milk. After about 15-20 minutes, you should check your blood glucose level to see if you need to eat something else.

If you have a severe hypo, you may feel vague and confused, behave oddly and find it hard to concentrate, or even lose consciousness. If this happens, you will need someone else to help you drink or eat. If you have 2/3 mild hypos or a severe hypo, be sure to tell your doctor or nurse, so that you can work out how to stop it happening again. Regular hypos can lead you into a vicious circle as they make you more prone to further hypos with less and less warning that they are about to happen.

I find it really hard to swallow tablets, and I’m finding it more and more difficult to take all mine. Is there any alternative?

Chris

My pharmacist told me that one of my medicines was available as a powder that I could dissolve in a drink, so I asked my doctor to prescribe that. I think some medicines are available as tablets that melt in your mouth. It’s well worth asking.

Dominique

Insulins, eg: short, medium and long acting, or a mixture

An antidiabetic agent, used to reduce high blood sugar in patients with diabetes mellitus

Based on your life-style and the results ofyour blood sugar (glucose) tests and your previous insulin usage, your doctor will determine how much insulin you will need.It should be taken shortly (0–15 minutes) before or soon after meals

Hypoglycaemia

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Blood pressure treatmentIf you are taking medicines to reduce your blood pressure (and most people with type 2 diabetes also have high blood pressure) these are the main groups of drugs you may be offered. Within each group there may be several different drugs, whose names vary depending on which country you live in. Your doctor or nurse can explain which group your drug fits into. We have written the general (or ‘generic’) names of the drugs. You will see these names, usually in smaller print, on the packaging of your medicine. But you may know your medicines better by their brand names. These are usually the bigger names on the packaging.

Name of medicine Why you may be getting this medicine How you take it What it does

Most common unwanted effects to talk to your doctor or nurse about

ACE inhibitors, eg: lisinopril, ramipril, enalapril, perindopril

Used to treat blood pressure (hypertension)

The usual starting dose is one or two a day. Your doctor will adjust the amount you take until your blood pressure is controlled

Makes your blood vessels relax and widen and makes it easier for your heart to pump blood around your body

Dizziness, low blood pressure (causingdizziness especially on standing), cough,diarrhoea, being sick, headache, impairedkidney function

Angiotensin II blockers, eg: candesartan, valsartan, losartan, irbesartan

Used to treat blood pressure (hypertension)

The usual starting dose is one a day

Prevents the binding of angiotensin II to receptors, causing the blood vessels to relax which in turn lowers the blood pressure

Dizziness, low blood pressure with or without symptoms such as dizziness and fainting when standing up and decreased kidney function (signs of renal impairment)

Calcium channel blockers, eg: amlodipine, felodipine, nifedipine

Used to treat blood pressure (hypertension)

The usual starting dose is one a day

Widens the blood vessels. This creates less resistance to the blood flow, and results in lower blood pressure, which in turn reduces the strain on your heart

Headache, dizziness and tiredness

Diuretics, eg: bendroflumethiazide indapamide hydrochlorthiazide

Used to treat blood pressure (hypertension)

The usual starting dose is one a day

Diuretics help the body to get rid of extra fluid and are used in patients with high blood pressure. Because they get rid of fluid diuretics are sometimes called ‘water tablets’

Muscle weakness

Beta blockers, eg: atenolol, metoprolol, bisoprolol

Control high blood pressure Once daily – may be increased to twice daily

Lowers blood pressure Slow heart beat, feeling sick, cold hands and feet, diarrhoea, tiredness, aching and tired muscles, GI disturbances such as stomach pains, heartburn and constipation

Alpha blocker, eg: doxazosin, prazosin, indoramin

Treatment for high blood pressure

The usual dose is one tablet taken once a day

Relaxes blood vessels so that blood passes through them more easily. This helps to lower blood pressure

Feeling faint, ,headache, drowsiness or weakness, palpitations, feeling or being sick, lack of energy, depression or nervousness, constipation or diarrhoea, dry mouth, nasal stuffiness or blurred vision, shortness of breath or rash, swelling of the feet, ankles or legs, increase in frequency of passing urine

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Cholesterol treatmentIf you are taking medication to lower your cholesterol, these are the main groups of drugs you may be offered. Within each group there may be several different drugs, whose names vary depending on which country you live in. Your doctor or nurse can explain which group your drug fits into. We have written the general (or ‘generic’) names of the drugs. You will see these names, usually in smaller print, on the packaging of your medicine. But you may know your medicines better by their brand names. These are usually the bigger names on the packaging.

Top tips for getting your medicines right

Make a plan for taking your medicines, so you don’t forget – even when you’re really busy• Hang a calendar near the place you keep your medicines, and tick off each day when you have taken them• Put your tablets in a weekly or monthly pill box, with each day clearly marked. Then you can see whether • or not you’ve taken your medicineIf you’re getting any of the unwanted effects in the tables, discuss them with your doctor or nurse. They • may be able to change the drug or the dose, to reduce your problems or get rid of them completelyIf you’ve recently had two or more hypos, make an urgent appointment with your doctor or nurse to find • out what is going wrong

Name of medicine Why you may be getting this medicine How you take it What it does

Most common unwanted effects to talk to your doctor or nurse about

Statins, eg: simvastatin, atorvastatin, rosuvastatin, pravastatin, fluvastatin

Treats high levels of fats in the blood - also called ‘hyperlipidaemia’

One tablet usually taken in the evening

Works by reducing the amount of cholesterol and certain fatty substances called triglycerides in your blood

Headache, stomach pain, constipation, feeling sick, muscle pain, feeling weak, dizziness and increase in the amount of protein in the urine

Ezetimibe Used for patients who cannot control their cholesterol levels by diet alone

Usually one tablet taken per day

Lowers levels of total cholesterol

Abdominal pain, diarrhoea, flatulence, feeling tired

Fibrates, eg: bezafibrate, fenofibrate

Used where a low fat diet alone is not enough and where there is a risk of long-term effects associated with hyperlipidaemia

One tablet/capsule daily with water, after food in the morning or evening

Lowers high levels of cholesterol and other fats (lipids) in the blood (hyperlipidaemia)

Decreased appetite

Acid-binding resins, eg: colestyramine

Used to lower your body’s level of cholesterol (a type of fat) which can cause heart disease

Three to six sachets a day sprinkled on water or fruit juice as a divided dose or single dose

Lowers cholesterol levels – works in the digestive system and absorbs the cholesterol-containing bile acids, which then pass out the body in the faeces

Constipation, bloatedness and wind (flatulence)

Nicotinic acid Used when you can’t control your cholesterol levels with a statin, when you can’t tolerate a statin

One tablet a day with food – sometimes rising to two tablets after four weeks

Lowers ‘bad’ cholesterol (LDL) and raises levels of ‘good’ cholesterol (HDL)

Flushing – decreasing over time

Omega-3 fatty acid compounds

Treats high blood triglyceride levels

Usual dose is two capsules a day with meals, sometimes increasing to four capsules a day

Lowers triglycerides in the blood

Stomach problems and indigestion, nausea

All information regarding medicines has been taken from patient information leaflets. These can be found here www.medicines.org.uk/emc/

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Glossary

ACE inhibitor (angiotensin converting enzyme inhibitor): Medicine that blocks formation of angiotensin II – a natural substance that makes arteries narrower. Blocking it not only widens the arteries so that blood pressure goes down, it can also slow down the rate of kidney damage – a complication of diabetes.

Adipose tissue:Fat tissue made up of fat cells (adipocytes) which store energy as fat. Adipose tissue is found under the skin, around internal organs, in bone marrow and breast tissue. Excess fat tissue in the abdomen (measured by increased waist size) is associated with increased risk of type 2 diabetes, cardiovascular disease and some cancers.

Alphaglucosidase inhibitor: Diabetes medicine that works in the intestine to reduce digestion of carbohydrates from food into sugar that can be absorbed into the blood.

Artery: Blood vessel that carries blood away from the heart to other parts of the body.

BMI:Body Mass Index (BMI) is a measure of the relationship between weight and height that is associated with body fat and health risk. BMI = weight(kg) divided by height(m2) and the result (kg/m2) is your BMI.

Cardiovascular: Affecting the heart and circulation

Cerebrovascular: Affecting the blood vessels to/in the brain

Creatinine: Substance used to test how well the kidneys are working

Diastolic pressure:The blood pressure in the arteries when the heart relaxes, between beats. It is always lower than the systolic blood pressure. When blood pressure measurements are written down, the reading for the diastolic pressure is always written after that for systolic pressure. Both are measured in units of millimetres of mercury (mm Hg).

Diabetic retinopathy: Disease or damage to the retina at the back of the eye, usually caused when blood vessels which supply the retina with blood become damaged or blocked. The retina is the part of the eye where images are recorded before being passed to the brain. Damage to the retina can lead to blindness, but the risk of diabetic retinopathy can be reduced if blood glucose, blood pressure and cholesterol are well controlled.

DPP-4 inhibitor (dipeptidyl peptidase 4 inhibitor): Blocks an enzyme called dipeptidyl peptidase 4. This results in an increase in the hormone, incretin, stimulates the pancreas to release more insulin and the liver to make less glucose.

Erectile dysfunction:Also called impotence, it is an inability to get or keep an erection for sexual intercourse

HDL-cholesterol (high density lipoprotein-cholesterol): Often called “good cholesterol” as it helps to take cholesterol out of the blood and away from the arteries.

Hyperglycaemia: Too much sugar in the blood

Hypoglycaemia: Too little sugar in the blood

IFG (Impaired fasting glucose):Also called ‘pre-diabetes’ and is a term used to describe when a person has raised blood glucose in the fasting state which is not normal but not high enough to diagnose diabetes.

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IGT (Impaired glucose tolerance): Also called ‘pre-diabetes’, and is a term used to describe when a person has raised blood glucose levels (but not high enough to diagnose diabetes) in response to eating.

Incretins:Hormones produced in the intestines which increase the amount of insulin released by the pancreas and reduce the amount of glucose produced by the liver after eating.

Insulin:Hormone produced by the beta cells of the Islets of Langerhans in the pancreas, it makes cells in the liver, muscle and fat tissue take up glucose from the blood.

Insulin resistance: When insulin in the body becomes less effective at getting glucose out of the blood and into muscle and other cells. These cells become ‘resistant’ to its effects, so glucose levels in the blood start to rise.

LDL-cholesterol (low density lipoprotein-cholesterol): Also called ‘bad cholesterol’, as it is the type of cholesterol that builds up in the walls of arteries, making them diseased and stiff, and more likely to become narrow or blocked and to form clots. If arteries which supply the heart with blood become blocked in this way, this can lead to a heart attack. If arteries to the brain become blocked, this can lead to a stroke.

Metformin:Most commonly used first-line medicine for the treatment of type 2 diabetes. It is a biguanide medicine which reduces blood glucose levels by lowering the amount of glucose produced by the liver, and also helps the body to use insulin more effectively.

Neuropathy: Nerve damage

Prandial: At mealtimes

Post-prandial: After a meal. During the post-prandial phase, the pancreas should produce more insulin to control the level of glucose absorbed from food, and ensure that it moves from the blood into muscle and other cells. In diabetes, the pancreas may not produce enough insulin at mealtimes, or muscle and other cells may be resistant to its effects. As a result, glucose levels in the blood rise above healthy levels.

Sulfonylureas:Commonly used type of medicine for the treatment of type 2 diabetes which makes the pancreas produce more insulin and the body use it more effectively

Systolic blood pressure: The blood pressure in the arteries when the heart beats and pushes blood around the body. It is always higher than the diastolic blood pressure. When blood pressure measurements are written down, the reading for the systolic pressure is always written before that for diastolic pressure. Both are measured in units of millimetres of mercury (mm Hg).

Thiazolidinediones (TZDs): Another name for the glitazones, eg: pioglitazone. These drugs can be used on their own to treat type 2 diabetes, but are usually added to other medicines in the treatment of type 2 diabetes if the first drug does not give good enough control of blood glucose.

Triglycerides: Type of fat (lipid) absorbed from food and carried in the blood, high levels of which can lead to arterial damage and heart and circulatory disease.

Vein: Type of blood vessel which carries blood back to the heart from other parts of the body.

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ResourcesInternational Diabetes Federation (IDF): an umbrella organisation of over 200 national diabetes associations in over 160 countries. It represents the interests of people with diabetes and those at risk, and provides information about the condition. www.idf.org

European Association for the Study of Diabetes: organisation for healthcare professionals which promotes excellence in diabetes care through research and education. www.easd.org

Diabetes UK: the largest organisation in the UK working for people with diabetes, funding research, campaigning and helping people live with the condition. www.diabetes.org.uk

American Diabetes Association: the largest organisation in the US which funds research, delivers services, and provides information for people with diabetes www.diabetes.org

Healthtalkonline: award winning health website which includes compelling personal accounts of living with diabetes. www.healthtalkonline.org

Publications

Type 2 Diabetes Your Questions Answered by Rosie Walker and Jill Rogers Published by Dorling Kindersley in association with Diabetes UK (2006) ISBN 1405311502

Exercise Your Way to Health: Type 2 Diabetes by Paula Coates and Thuvia Flannery Published by A & C Black Publishers Ltd (29 Jan 2010) ISBN-10: 0713687207 ISBN-13: 978-0713687200

Healthy Eating for Diabetes by Antony Worrall Thompson and Azmina Govindji Published by Kyle Cathie; Revised edition (2 July 2009) ISBN-10: 1856268667 ISBN-13: 978-1856268660

The Essential Diabetes Cookbook by Antony Worrall Thompson with Louise Blair Published by Kyle Cathie (28 Jan 2010) ISBN-10: 1856268705 ISBN-13: 978-1856268707

Type 2 diabetes by Anthony Barnett. Published by Oxford University Press. ISBN-10: 0199539553, ISBN-13: 978-0199539550

Courses/programmes

Diabetes Care Course run by The Open University. For more information: www3.open.ac.uk/study/undergraduate/course/sk120.htm

Xpert Health: Diabetes – award winning structured programme for people with diabetes to develop the knowledge, skills and confidence to make informed decisions regarding lifestyle and diabetes self-management. Accessible at: www.xperthealth.org.uk

DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed). Programmes – education and support programmes for people with diabetes. Accessable at: www.desmond-project.org.uk

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References1. International Diabetes Federation. Diabetes Atlas, 4th edition, 2009 www.diabetesatlas.org/content/eur-data

2. International Diabetes Federation. What is diabetes? www.idf.org/node/1049?unode=3B96844A-C026-2FD3-87E85FD2293F42E9

3. Diabetes UK. Type 2 diabetes. Causes and risk factors. www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/Causes_and_Risk_Factors

4. International Diabetes Federation. Diabetes Atlas, 4th edition, 2009. www.idf.org/what-are-warning-signs-diabetes

5. Diabetes UK. www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/Signs_and_symptoms

6. National Institute for Health and Clinical Excellence. Type 2 diabetes. Guideline 87, May 2009

7. Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J. 2007 Oct;28(19):2375-414

8. International Diabetes Federation. Type 2 Diabetes Practical Targets and Treatments report (Asia Pacific Type 2 Diabetes Policy Group) 2005

9. Stratton I M, Adler AI, Neil H A et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ 2000; 321 (7,258): 405-12.

10. International Diabetes Federation. Treatment for diabetes. www.idf.treatment-diabetes (quoting UKPDS)

11. National Health Service (NHS). NHS Choices website. Available from www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx?Tag=

12. Diabetes UK. Ten steps to eating well www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Eating-well-with-Type-2-diabetes/Ten-steps-to-eating-well

13. Diabetes UK. Keeping active. www.diabetes.org.uk/Guide-to-diabetes/Healthy_lifestyle/Keeping_active/Before_you_start

14. Diabetes UK. Benefits of giving up smoking. www.diabetes.org.uk/Guide-to-diabetes/Healthy_lifestyle/Smoking/Benefits_of_giving_up

15. Diabetes UK. Calorie controlled plan. www.diabetes.org.uk/Guide-to-diabetes/Healthy_lifestyle/Managing_your_weight/Calorie_controlled_plan

16. Food Standards Agency. Making healthier choices www.eatwell.gov.uk/healthydiet/eatingouthealthily/healthierchoices

17. Food Standards Agency. Eight tips for healthy. www.eatwell.gov.uk/healthydiet/eighttipssection/8tips

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18. Diabetes UK. Treatments. Biguanide: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Tablets/Biguanide

19. Diabetes UK. Treatments. Sulphonylureas: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Tablets/Sulphonylureas

20. Diabetes UK. Treatments. Prandial glucose regulators: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Tablets/Prandial_glucose_regulator

21. Diabetes UK. Treatments. Thiazolidinediones (glitazones): www.diabetes.org.uk/Guide-to-diabetes/Treatments/Tablets/Thiazolidinediones_glitazones

22. Diabetes UK. Treatments. DPP-4 inhibitors (gliptins): www.diabetes.org.uk/Guide-to-diabetes/Treatments/Tablets/DPP-4-inhibitors-gliptins

23. Diabetes UK. Treatments. Alpha glucosidase inhibitor: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Tablets/Alpha_glucosidase_inhibitor

24. Diabetes UK. Treatments. Insulin: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Insulin

25. Diabetes UK. Treatments. Incretin mimetics: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Incretin-mimetics

26. Diabetes UK. Treatments. Blood Pressure: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Blood_Pressure

27. Diabetes UK. Treatments. Blood fat medications: www.diabetes.org.uk/Guide-to-diabetes/Treatments/Blood_fats_cholesterol/Blood_fat_medications

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Published by Bristol-Myers Squibb Company and AstraZeneca Pharmaceuticals LP, 2011.

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Editor – Barnett A, Anstiss T, Ceriello A, Cradock S, Hall G, Lloyd C, del Prato S, Vora J, Wens J, Felton A.