Endocrine disorders

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. Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chapatis, yams and plantain, from sugar and other sweet foods, and from the liver which makes glucose.

 

Insulin is vital for life. It is a hormone produced by the pancreas, that helps the glucose to enter the cells where it is used as fuel by the body.

 

There are two main types of diabetes mellitus:

Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. Type 1 diabetes is the least common of the two main types and accounts for between 5 – 15% of all people with diabetes.

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). In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people it often appears after the age of 25. However, recently, because of obesity more children are being diagnosed with the condition, some as young as seven. Type 2 diabetes is the most common of the two main types and accounts for between 85 - 95% of all people with diabetes.

There are currently over 2 million people with diabetes in the UK and there are up to another 750,000 people with diabetes who have the condition and don’t know it.

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 is caused by a number of risk factors. The risk factors are:

• 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’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.

The more risk factors that apply to you, the greater your risk of having diabetes.

The signs and symptoms of diabetes are:

• Increased thirst
• Going to the toilet (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. If you’re older you may put the symptoms down to ‘getting on a bit’.

Although diabetes cannot be cured, it can be treated very successfully.

Type 1 diabetes is treated by insulin injections and 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 levels as near to normal as possible. Other treatments may also be used to control blood pressure and reduce cholesterol levels. These treatments, together with a healthy lifestyle, will help to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.

The wide variety of medicines used to treat diabetes and the wide range of equipment needed to measure blood glucose levels can be extremely confusing for people with diabetes and their carers. Your pharmacist is there to help guide you through this confusion.

If you are using insulin, your pharmacist will be able to advise you about storing it correctly, what to do when you go on holiday and will suggest items such as pre-filled insulin pens that make selecting dosages and administration easier.

If you are taking tablets to control your diabetes, your pharmacist will let you know whether it is safe to take other medicines, in particular over the counter medicines and health supplements, you may be using to treat other illnesses.

Lancets used to prick your finger and test strips to test blood glucose levels are available on prescription, but the finger pricking devices and blood glucose meters are not. Your pharmacist will be able to let you know which equipment goes together and from where it may be obtained.

Talk to you pharmacist if you also want practical advice on life style changes such as stopping smoking, lowering cholesterol levels and changing your diet.

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 risk factors for Type 2 diabetes, you should ask your doctor for a test for diabetes.

 

Taking early action is key so if any of the symptoms apply to you, ask your doctor for a diabetes test.

• People with diabetes often have blood glucose levels that are higher or lower than normal, which may affect their health. If uncontrolled, big changes in blood glucose levels can cause health problems around the body, especially the cardiovascular system.
• Scientific research has shown that people who regularly monitor their blood glucose levels have fewer heart problems and a lower risk of death than those who do not monitor blood glucose levels
• It is important to monitor and control blood glucose levels regularly, even when feeling well, since you may not see the effects of uncontrolled blood glucose levels for many years

• You should work with your diabetes care team to set personalised blood glucose targets just for you. You can use self-monitoring regularly to check that you are working towards these targets
• Experts recommend that people with diabetes test before and after meals to gain the greatest benefit from their blood glucose monitoring. The best times to test are just before and 2 hours after the largest meal of the day. Worldwide diabetes guidelines outline the range of blood glucose levels that you might be aiming for if you are an adult with diabetes.

Blood glucose measurements	Target levels
Before a meal	6mmol/L
After a meal	8mmol/L

• If you use insulin, you should test at least three times every day. It is Important to test before breakfast, when you have not eaten for several hours, and can record fasting blood glucose levels .
• If you do not use insulin you can test less frequently. It is more useful to test several times during 1 or 2 days a week rather then once every day.
• An example of a self monitoring time table for you might like to use
  
  

• You should test more often if you have diabetes and are :
  • Pregnant
  • Elderly
  • Stressed or unwell (Including vomiting, diarrhoea or fever )
  • Changing medication; for example, starting a new oral drug or insulin regimen
  • Planning to drive, exercise or operate machinery
• Knowing your blood glucose pattern through frequent monitoring allows you to get on with your normal activities safely and without worry .
• Scientific research shows that people with diabetes who monitor their blood glucose levels as part of their diabetes care programme feel better and are less depressed about their diabetes.

 

Uncontrolled blood glucose level can affect several parts of the body, including:

• Eyes
• Feet
• Kidneys
• Heart
• Blood vessels
• Pancreas
• Skin
• Muscles
• The diagram below shows how people with diabetes often have very high blood glucose level after a meal.
  
  

Blood glucose monitoring

Record your measurements in a log book or a memory in a blood glucose meter

Discuss your blood glucose level with your diabetes care team to identify patterns of high or low blood glucose level

Agree to a treatment plan with your diabetes care team, Including specific blood glucose targets to control your blood glucose level

Monitor your blood glucose to check that your treatments are working to reach target blood glucose level

Your doctor or nurse may recommend to change your current treatments to help control blood glucose level

	Low blood glucose	High blood glucose
What should I look for?	Blood glucose reading 3-9mmol/L (At any time of day)	Several fasting blood glucose readings >11mmol/L
Signs	Trembling Clamminess Hunger Anxiety Sweating Confusion Headache	Thirst Frequent urination Hunger Dry mouth Dry or itchy skin Abdominal detension/Vomiting
Risks	Unable to function normally for example, when driving Fainting Coma	Long term damage affecting : Circulation in the feet and legs Blood vessels in the eye, affecting vision, and in the kidney Nerves and muscles Cardiovascular system, increasing the risk of diseases of the heart and circulation
What to do?	Raise blood glucose level by drinking half a cup of orange juice, a cup of milk or taking 2 or 3 glucose tablets Rest for 15 min then recheck your blood glucose levels Family members can inject glucagon in emergency situations (If you pass out)	Continue to check your blood glucose level regularly Adjust your meal and exercise plan as required If levels stay high check for ketones, adjust your insulin dose if you know how, or make an appointment to talk to your doctor Never stop taking your insulin

What is 'coding'?

• Manual coding is the process of calibrating – or ‘coding’- your blood glucose meter each time you start using a new box of test strips. You may have to enter the code number into the meter. This ensures that the meter is reading the test strips – and your blood glucose levels – correctly. Most blood glucose meters require manual coding before use.

What does coding mean to me?

• If you forget to code your meter, or make a mistake when coding, the meter may give you inaccurate blood glucose measurements. A miscoded meter will continue to give inaccurate readings until it is recalibrated with the correct code.
• A miscoded meter may produce an error of up to 4mmol/L in reported blood glucose levels
• To translate this into real life, if your blood glucose was 6.1mmol/L with a correctly coded meter, your test result might be as high as 8.7mmol/L if the meter was miscoded.
• Meters with no coding technology are available and automatically code to match the test strips – they can not be miscoded