What is Diabetes?

Diabetes Specialist Team

AIMS AND OBJECTIVES

• Have an understanding of the physiology of Diabetes

• Risk factors and identifying the at risk resident

• Screening options

Diabetes is set to become one of the most costly diseases in history.

Statistics• 2.8 million people diagnosed with diabetes in the

UK• An estimated 850,000 people in UK have the

condition and don’t know it• 3 people die from diabetes related complications

every hour• 100 toe, foot and lower limb amputations a

week are caused by diabetes• Approximately 10% of the NHS budget is spent

on diabetes• By 2025 it is estimated that over 4 million people

will have diabetes. Most of these cases will be type 2 diabetes, because of our aging population and rapidly rising numbers of over weight and obese people

What is Diabetes?

Diabetes is a condition where the body does not produce enough insulin

Or

The insulin does not work properly

Diabetes cannot be cured (yet)

Treatment depends on how much natural insulin is produced and how effective it is

Everyone with diabetes needs to consider their lifestyle and eating habits

TYPES OF DIABETES

• Type 1 Diabetes

• Type 2 Diabetes

• Gestational Diabetes

All serious conditions

Action of insulinInsulin is produced in the pancreas (in the beta cells)

The pancreas is situated behind the stomach

Insulin can only be given by injection

Insulin helps to move glucose into the cells for energy

Who is at Risk?Android (apple) vs. gynoid (pear) obesity

Waist circumference

Increased risk Substantial increased risk

Men above = 94cm above = 102 cm

37 ins 40 ins

Women above = 80cm above = 88cm

31.5 ins 35 ins

Type 1 Diabetes

• Unable to produce insulin due to autoimmune destruction of beta cells in the pancreas

• Without insulin free fatty acids build up producing ketones (toxins)

• Insulin essential for these individuals

• Usually affects children and people under 30 years of age

Signs and symptoms of type 1• Usually rapid onset of symptoms

• Lethargy

• Weight loss usually dramatic

• Polyuria (passing large amounts of urine)

• Polydipsia (excessive thirst)

• Presence of ketones - drowsy, pear drop smell deep breathing, may lapse in to coma if untreated

• Needs insulin within the first year of diagnosis

Always consider the possibility of Type 1 diabetes regardless of age

Type 2 - Who is at Risk?

• Age 40 years or older• First degree relative with diabetes• Overweight (waist measurement)• Sedentary lifestyle• Heart Disease • Cataracts • Gestational diabetes (during pregnancy)• People of South Asian or African Caribbean

background have a much higher prevalence 4-6 times more likely to develop type 2 diabetes

Type 2 Diabetes

• Usually the result of or a combination of insulin resistance/beta cell failure

• It is a progressive condition

• May require insulin therapy

Signs and symptoms of type 2

• Usually a gradual onset • Tiredness• Weight loss• Blurred vision• Polyuria• Polydipsia• Recurrent infections• May be asymptomatic• Not usually prone to ketoacidosis

Foods containing Carbohydrates CHO’s

All Foods containing CHO’s breakdown into glucose• Examples• Starchy CHO’s e.g. Bread, potatoes, pasta, cereal• All Fruit – contains natural sugar (fructose)• Dairy - Milk, yogurt & fromage frais (not cheese)• Sugary foods – cakes, biscuits, sweets etc

Digestion

• All Carbohydrates are broken down into glucose

• Glucose is the body’s fuel essential for energy

• All the body’s cells need glucose for energy

• CHO’s have an immediate affect on blood glucose levels

Glucose leaves the stomach & enters the blood stream

How does glucose get into the bodies cells?

• On ingestion of eating CHO’s the pancreas releases a hormone called insulin

• Insulin acts like a ‘key’. It allows glucose into the muscle cells

Pancreas

Action of insulin

Insulin allows the Glucose to leave the blood & enter the

muscle cells in the body to be used as energy

BLOOD VESSEL MUSCLE CELLSINSULIN

Digestion process

• Normal Blood glucose levels • Before food 4 -7mmol/l• 2 hours after food less than

8.5mmol/l• Aim for under 10mmol/l• Normally takes approx 2

hours to break down CHO’s

Type 1 Diabetes

• The pancreas stops making insulin

• Cells unable to access glucose• Insulin therapy required to

survive

• Approximately 5-10% of people have type 1 diabetes

• Often diagnosed in childhood but can occur at any time of life

Type 2 Diabetes

• The pancreas still makes insulin but the insulin doesn’t work properly, obesity can cause this – insulin resistance

Or • The pancreas does not produce

enough insulin – beta cell failure• Approximately 90% of patients will

have Type 2 diabetes.

Management

AIMS OF MANAGEMENT

Normalise life style

Maintain long term health

Relieve symptoms of hyperglycaemia

Avoid hypoglycaemia

Avoid long term complications

Possible complications of diabetes

What can we do?• Encourage a healthy diet and lifestyle

• Encourage Physical Activity

• Encourage smoking cessation

• Ensure compliance with treatment as prescribed

• Regular diabetes review’s

Be aware of at risk patients and request assessment by healthcare professional or GP

Identyfying the at risk patient

Complete a risk assessment?Many nursing home patients may score at riskBecause they are• Elderly• May be overweight• Raised waist circumference• Have other conditions such as heart disease,

hypertension which increase their risk

Identifying the at risk patient

Consider any changes • Polyurea• Polydipsia• Frequent infections thrush, UTI• More sleepy• Signs of dehydration• Behaviour change

Screening options

• Routine testing of urine for glucose in the home.

• Postive result then arrange for blood test.• Blood glucose test as part of annual health

check

Screening options

Recent guidelines have said identifying or diagnosing patients can be by fasting plasma glucose or HbA1c both of which should be venous samples.

HIGH RISK• Fasting glucose 5.5 – 6.9 mmol/l• HbA1c 42 – 47 mmols

Screening options

Diabetes can only be diagnosed by venous blood tests.

Either• One positive test FPG 7 mmols or above or

HbA1c 48mmols/mol or above and symptoms e.g. Thirst, polyuria etc.

Or• Two positive blood tests which must be the

same e.g. 2 FPG or 2 HbA1c