Diabetes, type 1
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In the UK, diabetes affects approximately 2.3 million people, and it's thought there are at least half a million more people who have the condition but are not aware of it.
How does diabetes occur?
Normally, the amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, insulin moves any glucose out of the blood and into cells, where it is broken down to produce energy.
However, in those with diabetes, the body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or because the insulin that is there does not work properly.
There are two types of diabetes - type 1 and type 2. This article focuses on type 1 diabetes (go to 'useful links' for information about type 2 diabetes).
What is type 1 diabetes?
Type 1 diabetes occurs when the body produces no insulin. It is often referred to as insulin-dependent diabetes. It is also sometimes known as juvenile diabetes, or early-onset diabetes, because it usually develops before the age of 40, often in the teenage years.
Type 1 diabetes is far less common than type 2 diabetes, which occurs when there is too little insulin produced by the body to work, or when the cells in the body do not react properly to insulin. People with type 1 diabetes make up only 5-15% of all people with diabetes.
If you have type 1 diabetes, you will need to take insulin injections for life. You must also make sure that your blood glucose levels stay balanced by eating a healthy diet and carrying out regular blood tests.
Diabetes in pregnancy (gestational diabetes)
During pregnancy, some women have such high levels of glucose in their blood that their body cannot produce enough insulin to absorb it all. This is known as gestational diabetes, and it affects approximately 2% of pregnant women.
Pregnancy can also make existing type 1 or type 2 diabetes worse.
Gestational diabetes can increase the risk of health problems in an unborn baby, so it is important to keep the levels of glucose in your blood under control.
In most cases, gestational diabetes develops in the second half of pregnancy and disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.
Symptoms of type 1 diabetes
The main symptoms of diabetes are:
- feeling very thirsty,
- producing excessive amounts of urine,
- tiredness, and
- weight loss and muscle wasting (loss of muscle bulk).
Symptoms of type 1 diabetes can develop quickly, over weeks or even days. Other symptoms are:
- itchiness around the vagina or penis or getting thrush regularly,
- blurred vision (caused by the lens of your eye becoming very dry),
- constipation, and
- skin infections.
Hypoglycaemia (low blood glucose)
If you have diabetes, your blood glucose levels can become very low. This is known as hypoglycaemia (or a 'hypo'), and happens because any insulin in your body has moved too much glucose out of your bloodstream.
In most cases, hypoglycaemia occurs if you take too much insulin, although it can happen if you skip a meal, exercise very vigorously or drink alcohol on an empty stomach.
Symptoms of a 'hypo' include:
- feeling shaky and irritable,
- tingling lips,
- feeling weak,
- hunger, and
- nausea (feeling sick).
A hypo can be brought under control simply by eating or drinking something sugary (see 'treatment'). If a hypo is not brought under control it can lead to confusion, slurred speech and unconsciousness.
If this occurs, you will need to have an emergency injection of a hormone called glucagon. This hormone will raise the level of glucose in your blood.
Hyperglycaemia (high blood glucose)
As diabetes occurs as a result of your body being unable to produce any, or enough, insulin to regulate your blood glucose level, your blood glucose levels may become very high. This happens because there is no insulin to move glucose out of your bloodstream and into your cells to produce energy.
If your blood glucose levels become too high, you may experience hyperglycaemia. The symptoms are similar to the main symptoms of diabetes, but they may come on suddenly and severely. They include:
- extreme thirst,
- a dry mouth,
- blurred vision,
- drowsiness, and
- a frequent need to pass urine.
If left untreated, hyperglycaemia can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death. Diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build-up of acids in your blood.
Seek urgent medical attention if you have diabetes and you develop:
- a loss of appetite,
- nausea or vomiting (feeling or being sick),
- a high temperature,
- stomach pain, or
- a fruity smell on your breath, which may smell like pear drops or nail varnish.
How can gestational diabetes affect my baby?
Gestational diabetes (diabetes in pregnancy) can cause an increased risk of developing congenital health problems, such as a heart defect or breathing difficulties.
Your baby may also be born with a high birth weight. This can make labour difficult, and you may need to have a caesarean section.
Once born, your baby's blood glucose level may be lower than usual, and will need to be monitored. They are also more likely to develop jaundice.
Causes of type 1 diabetes
Type 1 diabetes occurs because your body cannot produce any insulin, a hormone that is needed to control the amount of glucose (sugar) in your blood.
When you eat, your digestive system breaks down food and passes its nutrients into your bloodstream. Normally, insulin is produced by your pancreas to take any glucose out of your blood and move it into your cells, where it is broken down to produce energy.
However, if you have type 1 diabetes, there is no insulin to move glucose out of your bloodstream and into your cells.
What causes type 1 diabetes?
The exact cause of type 1 diabetes is not fully understood, although in most cases it is believed to be an auto-immune condition. This means it occurs as a result of your body's immune system mistaking a natural substance in your body as harmful, and attacking it.
In the case of type 1 diabetes, it is thought that the immune system attacks cells in your pancreas, destroying or damaging them enough to stop insulin production. It is not known exactly what triggers the immune system to do this, but it may be due to infection with a particular virus.
Type 1 diabetes tends to run in families, so there may also be a genetic cause for the auto-immune reaction. If you have a close relative, such as a parent or sibling (brother or sister) with type 1 diabetes, you have roughly a 6% chance of developing the condition yourself. The risk for people who do not have a close relative with type 1 diabetes is approximately 0.4%.
In rare cases, type 1 diabetes may be caused by a condition of the pancreas called pancreatitis. Pancreatitis causes your pancreas to become inflamed, resulting in severe damage to the cells that produce insulin.
Causes of diabetes in pregnancy
It's not known why some women develop diabetes when they are pregnant, although there are several factors that make it more likely. You may be at risk of developing gestational diabetes while you are pregnant if you:
Diagnosing type 1 diabetes
It is important to diagnose diabetes as early as possible so that treatment can be started. If you experience symptoms, you should see your GP as soon as possible. They will ask you about your symptoms and ask for a urine sample.
Your urine sample will be tested to see if it contains glucose. Normally, urine does not contain glucose, but if you have diabetes, some glucose can overflow through the kidneys and into the urine.
If your urine contains glucose, your GP will also carry out a blood test, which can confirm the diagnosis of diabetes. A sample of your blood will be taken in the morning, before you have had anything to eat, and it will be tested to measure your blood glucose levels.
If your blood glucose levels are not high enough for your GP to diagnose diabetes, you may need to have an oral glucose tolerance test. This is also sometimes referred to as a glucose tolerance test (GTT). Your GP will give you a glucose drink and take blood tests every half an hour, for two hours, to see how your body is dealing with the glucose.
If you are diagnosed with diabetes, your GP may do further blood and urine tests to find out whether you have type 1 or type 2 diabetes. However, in some cases it may be clear to your GP from your symptoms and medical history which type of diabetes you have.
You may be diagnosed with type 1 diabetes if you are found to have antibodies that attack insulin-producing cells in your blood, or if you have acids in your urine.
Diagnosing diabetes in pregnancy
Your GP or midwife may test your urine for glucose at your antenatal appointments.
If your urine contains glucose, your GP or midwife may test you for gestational diabetes using the oral glucose tolerance test.
Treating type 1 diabetes
Diabetes cannot be cured, but treatment aims to keep your blood glucose levels as normal as possible, and to control your symptoms in order to prevent health problems developing later in life.
If you have been diagnosed with diabetes, you'll be referred for specialist treatment from a diabetes care team. Your care team will be able to explain your condition to you in detail and help you to understand your treatment. They will closely monitor your condition in order to identify any health problems that may occur.
As well as receiving medical treatment, there are a number of ways you must treat the condition yourself (see the 'self help' section).
As type 1 diabetes occurs because your body cannot produce any insulin, you will need to have regular insulin treatment for life in order to keep your glucose levels normal.
Insulin comes in several different preparations, which each work slightly differently. For example, some are long-acting (lasting up to a whole day), some are short-acting (lasting up to eight hours), and some are rapid-acting (which work quickly, but do not last very long). Your treatment may include a combination of these different insulin preparations.
In most cases of type 1 diabetes, you'll need to have insulin injections. Insulin must be injected because the enzymes in your stomach would not be able to digest it if it was taken as a tablet. When you are first diagnosed, your diabetes care team will help you with your insulin injections, before showing you how and when to do it yourself. They will also show you how to store your insulin and dispose of your needles properly.
Insulin injections are given using a syringe or an injection pen, which is also called an insulin pen (auto-injector). Most people need two to four injections a day. Your GP or diabetes nurse will teach one of your close friends or relatives how to inject the insulin properly.
Insulin pump therapy:
This is an alternative to injecting insulin. An insulin pump is a small device (about the size of a pack of playing cards) that holds insulin.
The pump is attached to you by a long piece of thin tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but you could also insert it into your hips, thighs, buttocks or arms.
The pump allows insulin to flow into your bloodstream at a rate that you can control. This means you no longer need to give yourself injections, although you will need to monitor your blood glucose levels very closely to ensure you are receiving the right amount of insulin.
Insulin pump therapy can be used by adults, teenagers and children (with adult supervision) who have type 1 diabetes. However, it may not be suitable for everyone. Your diabetes care team may suggest pump therapy if you often have hypoglycaemia (low blood glucose).
Insulin jet system:
This is a new device for delivering insulin without using a needle, and is now available on the NHS. The insulin jet system can be used on your stomach, buttocks and thighs.
It works by forcing a very small stream of insulin through a nozzle that is placed against your skin. The insulin travels at a very high speed and goes through your skin. Your diabetes care team will be able to advise you about whether this method of insulin delivery is suitable for you.
Monitoring your own blood glucose levels
An important part of your treatment will be making sure your blood glucose level is as normal and stable as possible.
You will be able to manage this using insulin treatment and by eating a healthy diet, but you'll also have to regularly check your blood glucose levels to make sure they are not too high or too low.
Exercise, illness, stress, drinking alcohol, taking other medicines and (for women) changes to hormone levels during the menstrual cycle can all affect your blood glucose levels.
In most cases, you'll need to check your blood glucose levels at home using a simple finger prick blood test. You may need to do this up to four or more times a day, depending on the type of insulin treatment you are taking. Your diabetes care team will talk to you about your ideal blood glucose level.
The normal blood glucose level is 4.0-7.0 mmol/l before meals, and less than 9.0 mmol/l two hours after meals. Mmol/l means millimoles per litre, and it is a way of defining the concentration of glucose in your blood.
Having your blood glucose levels checked
As well as monitoring your own blood glucose levels every day, your GP or diabetes care team will need to take a reading of your average blood glucose level every two to six months. This shows how stable your glucose levels are over time, and how well your treatment plan is working.
The test you will have to measure your average blood glucose level is known as the HbA1c test, or A1c for short. HbA1c is the name given to red blood cells that have glucose attached to them, and measuring them can highlight the amount of glucose that has been in your blood over the past six to 12 weeks.
A high HbA1c level can mean that your blood glucose level is consistently high, and your diabetes treatment plan may need to be altered.
Treating hypoglycaemia(low blood glucose)
Hypoglycaemia can occur when your blood glucose level becomes very low. It is likely that you will develop hypoglycaemia from time to time.
Mild hypoglycaemia (or a 'hypo') can make you feel shaky, weak and hungry, and can be controlled by eating or drinking something sugary, such as a fizzy drink (not diet), sugar cubes or raisins. You may also be able to take pure glucose in a tablet or fluid, if you need to control the symptoms of a hypo quickly.
However, if you develop severe hypoglycaemia, you can become drowsy and confused, and you may even lose consciousness. If this occurs, you will need to have an injection of glucagon into your muscle, which is a hormone that quickly increases your blood glucose levels.
If you have type 1 diabetes, you may need to carry glucagon with you at all times, and your diabetes care team may show several of your family members and close friends how to inject the glucagon into your muscle, should you need it.
Once you begin to come round, you will need to eat something sugary once you are alert enough to do so. If you lose consciousness as a result of hypoglycaemia, there is a risk that it may happen again within a few hours, so you will need to rest afterwards and have someone with you.
If the glucagon injection into your muscle does not work, and you are still drowsy or unconscious 10 minutes after the injection, you will need urgent medical attention.
You'll need to have another injection of glucagon straight into a vein, which must be given by a trained healthcare professional.
Treating hyperglycaemia(high blood glucose)
Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin.
If hyperglycaemia occurs, you may need to adjust your diet or your dosage of insulin, in order to keep your glucose levels normal. Your diabetes care team will advise you about the best way to do this.
However, if hyperglycaemia is left untreated, it can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death.
Diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build-up of acids in your blood. See the 'symptoms' section for the warning signs of diabetec ketoacidosis.
If you develop diabetic ketoacidosis, you will need to have urgent treatment in hospital. You will be given insulin directly into a vein (intravenously). If you are dehydrated, you may also need to have other fluids given by a drip, including saline (salt solution) and potassium.
If you have type 1 diabetes, you have an increased risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:
- anti-hypertensive medicines to control high blood pressure,
- a statin, such as simvastatin, to reduce high cholesterol levels,
- low-dose aspirin to prevent stroke, and
- angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, if you have the early signs of diabetic kidney disease.
Diabetic kidney disease is identified by the presence of small amounts of albumin (a protein) in your urine. It is often reversible if treated early enough.
It is also recommended that you have an influenza (flu) vaccine each year and a one-off pneumococcal polysaccharide vaccine (PPV), because these infections can be particularly unpleasant and more serious if you have diabetes.
Diabetes in pregnancy
If you developed diabetes while you were pregnant, it is likely your blood glucose levels will return to normal after your baby is born.
If you had diabetes before you became pregnant, you'll need to continue to treat and manage your condition with the help of your care team.
If you have type 1 diabetes, you'll need to look after your health very carefully.
As well as treating yourself with insulin and monitoring your blood glucose levels, there are many other ways that you should manage your condition.
Some people think that having diabetes means that you have to follow a diet of special foods, but this is not true. If you have diabetes, your diet should be the same as that of anyone else - high in fibre, fruit and vegetables, and low in fat, salt and sugar.
However, different foods will affect you in different ways, so it's important to know what to eat and when to get the right amount of glucose for the insulin you are taking. A diabetes dietician will be able to help you work out a dietary plan that can be fitted to your specific needs.
Get regular exercise
Physical activity lowers your blood glucose level, so it is particularly important to exercise regularly if you have diabetes.
Like anyone else, you should aim to do at least 30 minutes of moderate exercise, at least five times a week. This can be any activity that gets you slightly out of breath and warmer than usual. However, you should not start a new activity without first seeing your GP or care team.
As exercise will affect your blood glucose level, you and your care team may have to adjust your insulin treatment or diet plan, to keep it steady.
Let others know about your condition
If you have type 1 diabetes, you should wear an identity bracelet to let others know that you have the condition. This will ensure that if you collapse, emergency medical professionals will be quickly made aware that you have diabetes.
You should also carry a glucagon kit with you, in case of hypoglycaemia (low blood glucose). Your diabetes care team should train you and several of your family members and close friends on how to use it.
Do not smoke
If you have diabetes, you have an increased risk of developing a cardiovascular disease, such as a heart attack or stroke. If you also smoke, you are increasing this risk even further, as well as increasing your risk of other smoking-related conditions, including lung cancer.
If you smoke, your GP can provide treatment and support to help you to give up.
Drink alcohol in moderation
You should only drink alcohol in moderation if you have diabetes, and you should never drink alcohol on an empty stomach. Depending on the amount you drink, alcohol can cause either high or low blood glucose levels (hyperglycaemia or hypoglycaemia).
Drinking alcohol may also affect your ability to carry out your insulin treatment, or blood glucose monitoring, so always be careful not to drink too much.
Look after your feet
Having diabetes means you are more likely to develop problems with your feet, including infections and foot ulcers (see 'complications').
To prevent this, you should keep your nails short and wash your feet with warm water every day. Wear shoes that fit properly and see a podiatrist or chiropodist (a specialist in foot care) regularly, so that any problems are found early.
You should also check your feet often for any cuts, blisters or grazes because you may not be able to feel them if there is damage to the nerves in your feet. See your GP if you have a minor injury to your foot that does not start to heal within a few days.
Have regular eye tests
If you have type 1 diabetes, you should have your eyes tested at least once a year to check for retinopathy.
Retinopathy is an eye condition where the small blood vessels in your eye become damaged (see 'complications'). It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). If it is untreated, retinopathy can eventually lead to blindness.
Having regular eye tests should mean that any signs of retinopathy are picked up as soon as they appear.
Complications caused by diabetes
If your diabetes isn't treated, it can lead to many different health problems. Large amounts of glucose can damage blood vessels, nerves and organs, and even a mildly raised glucose level that doesn't cause any symptoms can have damaging effects in the long term.
Heart disease and stroke
If you have diabetes, you're up to five times more likely to suffer heart disease and stroke compared with people without diabetes. Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis (furring up and narrowing of the blood vessels). This may result in poor blood supply to the heart, causing angina. It also increases the chance that a blood vessel in your heart or brain will become completely blocked, causing a heart attack or stroke.
High blood glucose levels can damage the tiny blood vessels of your nerves. This can lead to a tingling or burning pain that spreads from your fingers and toes up through your limbs. If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation.
Retinopathy (damage to the retina at the back of the eye)
Blood vessels in the retina of your eye can become blocked, leaky or grow haphazardly. This prevents the light from fully passing through to your retina. If left untreated, it can damage your vision.
The better you control your blood sugar levels, the less chance you have of serious eye problems. Having an annual eye check by a specialist (an ophthalmologist or an optometrist) can help to pick up signs of any potentially serious eye problems early on, so that they can be treated.
Diabetic retinopathy can be managed by laser treatment if it's caught early enough. It's important to realise, however, that this will only preserve the sight you have, not make it better.
If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. In rare, severe cases, this can lead to kidney failure and the need for a kidney transplant.
Damage to the nerves of the foot can mean that small nicks and cuts are not noticed, leading to the development of a foot ulcer. About one in 10 people with diabetes get foot ulcers, which can cause serious infection.
Check your feet every day and report any changes to your doctor, nurse or podiatrist. Look out for sores and cuts that don’t heal, puffiness or swelling and skin that feels hot to the touch. You should also have a foot examination at least once a year.
Impotence in men (erectile dysfunction)
Damage to the nerves and blood vessels can lead to erection problems in men, especially in men who smoke. This may be treated with medication.
In general, your risk of developing complications is greatly reduced if your blood glucose level is well controlled and if other risk factors, particularly high blood pressure and high cholesterol, are properly controlled.
Miscarriage and stillbirth
Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If their blood sugar level is not carefully controlled in the early stages of pregnancy, there is also an increased risk of the baby developing a serious birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or in a diabetic clinic, where doctors can keep a close eye on their blood sugar levels and control their insulin dosage more easily.
Looking after your eyes
The National Diabetic Retinopathy Screening Programme will arrange for you to have your eyes checked every year. From December 2007, everyone on a diabetes register will be offered the opportunity to have a digital picture taken of the back of their eye. To register, speak to your GP.
Bupa. (2008). Diabetes in pregnancy [online] Available at http://www.bupa.co.uk/ [Accessed 9th June 2008].
Diabetes UK. (2006) Causes and Risk Factors [online]
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Diabetes UK. (2006) Insulin pump therapy: also known as continuous subcutaneous insulin infusion(CSII) [online] Available at http://www.diabetes.org.uk [Accessed 13th June 2008].
Diabetes UK. (2006) What is diabetes? (whole section)
[online] Available at http://www.diabetes.org.uk [Accessed 9th June 2008].
Hicks, R. (2006). Symptoms of diabetes [online] BBC Health. Available at http://www.bbc.co.uk/health/ [Accessed 9th June 2008].
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NHS Choices links
Diabetes expert Grace Vanterpool on the questions to ask
We asked Grace Vanterpool, a diabetes consultant nurse at Hammersmith and Fulham Primary Care Trust, what she would want to know if she was diagnosed with diabetes.
Will I need injections?
People with type 1 diabetes have no insulin in their bodies and will need insulin injections.Your doctor will put you in touch with your diabetes nurse, who will teach you and assist whenever necessary.
Will I have to give up sugar?
What you eat directly affects the level of glucose, fat and salt in your blood. You'll need to cut down on sugar and sugary foods because these directly affect your blood glucose levels. By choosing a healthier diet that’s high in fibre, fruit and vegetables and low in sugar, fat and salt, you can reduce your chance of developing complications.
You don’t need to buy special diabetic food. When you're newly diagnosed, you'll be referred to a dietitian. By sticking to your management plan, monitoring your condition and following a healthy lifestyle, you should be able continue with daily activities that you enjoy.
Are there foods that will be beneficial to me?
Eat regular meals based on carbohydrates. Foods such as bread, potatoes and rice will help to control your glucose levels. All varieties are fine but wholegrain ones are best.
Can I still drink alcohol?
Yes, but in moderation. According to national guidelines that means no more than 21 units of alcohol a week for men and no more than 14 units for women.
How important is exercise?
Physical activity is just as important as healthy eating so make it part of your management plan. Exercise helps to regulate blood glucose levels. Do a physical activity that makes you feel a little out of breath, but so you can still talk, for at least 30 minutes each day.
NHS Choices links
Eating the right food
There is no ‘special’ diet for people with diabetes. Along with the rest of the population, people with diabetes are advised to eat a healthy, balanced diet low in fat, sugar and salt and with plenty of fresh fruit and vegetables.
Dr Sarah Schenker, one of the UK’s leading dieticians, gives her top diabetes diet tips.
Eat plenty of starchy carbohydrates
- Choose carbohydrate foods that have a low glycaemic index (GI). Low GI foods release their energy slowly into the bloodstream and help to keep blood sugar levels more stable.
- Try not to eat too many high GI foods, especially between meals, as these foods can cause blood sugar levels to rise quickly.
Have regular meals and snacks
- Eat breakfast. By the morning, your body has been without food for many hours, and blood sugar levels can be low. A bowl of wholegrain cereal or a toasted bagel with peanut butter boosts your energy levels and sets you up for the day ahead.
- Eat healthy snacks between meals, such as yoghurts, fruit, low-fat cheese and crackers, vegetables sticks with a healthy dip.
- Don't skip meals.
Reduce your intake of unhealthy fats
- Add pulses, beans and lentils as a healthy alternative to meat when making stews, curries or casseroles.
- Choose low-fat dairy products, such as semi-skimmed milk and low-fat yoghurts.
- Always check labels on food, and avoid products that contain hydrogenated fats.
- Avoid fatty meats and meat products. Choose lean cuts of meat and remove visible fat and skin.
- Don't eat fried foods, fast foods and too many pastries, cakes, buns and biscuits.
Keep well hydrated and stick to alcohol guidelines
- Sip water and other healthy drinks throughout the day and carry a bottle of water with you wherever you go.
- Drink alcohol sensibly.
- Don’t let yourself get dehydrated. By the time you feel thirsty it’s too late; you’re already dehydrated.
- Don't overdo it. People with diabetes should be extra-careful not to binge drink, drink too quickly or drink on an empty stomach. If you do drink regularly, aim to have a few alcohol-free days each week.
Choose low GI foods
Try these alternatives:
Try these tasty and healthy recipes:
(Links open in new windows)
Or, try the Diabetes UK online guide to shopping and menu planning to find out how balanced your shopping basket is, and for everything you need to know about food and food labelling.
Diabetes and pregnancy
If you have diabetes and have learned that you're pregnant, you'll experience all the emotions that come with having a baby but you'll probably also be concerned about the effect your diabetes could have on you and your child. Because of your diabetes, you'll have extra challenges to deal with during your pregnancy. The most important challenge is keeping your blood sugar under tight control, particularly before becoming pregnant and during the first eight weeks when your baby is developing. You should also:
- Check your medications. Tablets used to treat type 2 diabetes may harm your baby, so you may have to switch to insulin injections.
- Take a higher dose of folic acid tablets. Folic acid helps to prevent your baby from developing spinal cord problems. Doctors now recommend that all women planning to have a baby take folic acid. Women with diabetes are advised to take 5mg each day (only available on prescription).
- Have your eyes checked. Retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes. Pregnancy can place extra pressure on the small vessels in your eyes, so it’s important to treat retinopathy before you become pregnant.
Your GP or diabetes care team can give you further advice. Diabetes UK also provides useful information to help you get your pregnancy off to a healthy start.
Diabetes and your child
For any parent whose child is diagnosed with a life-long, chronic condition, the tough job of parenting becomes even tougher. Although living with type 1 diabetes means coming to terms with the diagnosis, getting to grips with treatment and making adjustments to daily life, the normal and healthy life you wanted for your child is still possible.
Diabetes UK Care Advisor Libby Dowling offers her advice to parents of children with diabetes.
- Get the knowledge. Make sure you understand what diabetes is, what blood glucose targets are and what your child should aim for, and how insulin or insulin pumps work. Don’t be afraid to ask any questions you want of your healthcare team. No question is a silly question, and it’s more than likely they’ve heard it before. Ask your healthcare team for relevant leaflets about diabetes that you can take away.
- Get the skills. Make sure you're confident about the practical aspects of your child’s care. Know how to inject or manage a pump, monitor blood glucose, treat hypos, provide a healthy balanced diet and know how illness, such as colds or fever, can affect your child’s blood glucose levels.
- Know what care to expect. Your child has the right to be treated by a specialist paediatric diabetes team (and not just in a general paediatric clinic). You should also have access to a paediatric diabetes specialist nurse (PDSN). Ask for the contact numbers for your healthcare team in case of emergencies.
- Get emotional support and start talking. Feelings of depression, guilt or anger are normal, so talk to your healthcare team or ask to see a psychologist for you or your child. Ask to meet another family or go on a Diabetes UK family support weekend. Meeting other families and knowing that you’re not alone always helps. Ask your healthcare team about local support groups or if they can put you in touch with another parent. Diabetes UK has trained counsellors who can give support. Call the Careline on 0845 120 2960, between 9am and 5pm, Monday to Friday.
- Work with your child’s school and teachers. Agree on a healthcare plan for your child, with the school and your PDSN. This should cover who gives injections and monitors blood glucose and when, and whether a private area is available if your child isn't comfortable injecting in front of their classmates. Other things to consider are: sharps disposal, sweet snacks in case of hypos, PE and other sporting activities. School is a big part of a child’s life so take the time to ensure that the head teacher, teachers and classmates are educated and involved.
- Make sure life goes on. Let your child and yourself experience normal daily routines. If your child used to spend afternoons or sleepovers at friends’ houses, ensure that this still happens. You can't be with your child 24 hours a day, so share responsibility and allow your family and friends to help. If you have other children, make sure they’re getting your attention too. Don’t rule out sweets completely: diabetes means low sugar, not no sugar.
You’ll be best equipped to manage your diabetes on a day-to-day basis if you’re given information and education when you’re diagnosed and then on an ongoing basis.
In 2001, the Department of Health published a national service framework for Diabetes. The purpose of this was to improve the standards of care for everyone with diabetes. The national service framework says that people with diabetes should have information and education to help them self care.
What is structured patient education?
Structured patient education means that there's a planned course that:
- covers all aspects of diabetes,
- is flexible in content,
- is relevant to a person’s clinical and psychological needs, and
- is adaptable to a person’s educational and cultural background.
How do I know if I am receiving good structured education?
The Department of Health together with Diabetes UK set up a group to support good structured education. The group has developed some guidance and published a report so that you can judge whether the education you're getting about your diabetes is of a high standard. If you're not sure, you should ask your diabetes team.
A good planned education course should:
- Provide a written outline, so that you can see what will be taught on the course.
- Be delivered by trained educators. As a minimum the course should be given by someone who understands the principles of patient education and has been assessed as competent to teach the programme.
- Be quality assured to make sure it's of a consistently high standard.
- Provide the opportunity for feedback to show that it's making a difference to the people who go on it.
What course should I go on?
You need to go on a course that meets your needs and will support you. Different courses will suit different people, depending on things such as what type of diabetes they have, and how long they have had it.
- Courses should reflect established methods of adult learning and the curriculum should be clearly written down.
- Courses should be run by appropriately trained professionals from a variety of backgrounds (such as nurses and dietitians) to groups of people with diabetes, unless group work is considered unsuitable for an individual.
- Sessions should be accessible to the broadest range of people, taking into account the person’s culture, ethnicity, any disability they might have and where they live.
- Sessions should be held locally, for instance in a community setting or local diabetes centre.
- Courses should use a variety of teaching styles to promote active learning, where everyone gets involved and can relate what they're learning to their own experiences.
- Courses should be adapted to meet the different needs, personal choices and learning styles of people with diabetes.
- Education should become part of your normal diabetes care.
For type 1 diabetes, there is a national patient education programme that meets all the key criteria for structured education. This is called DAFNE (Dose Adjustment for Normal Eating).
DAFNE is a skills-based course in which people with type 1 diabetes learn how to adjust their insulin dose to suit what they eat, rather than having to eat to match their insulin doses.
NHS Choices links
'I like to think Suzy is the strong character she has become because of the diabetes'
When Bonnie Estridge’s daughter was diagnosed with type 1 (insulin dependent) diabetes 16 years ago, just before her seventh birthday, she and her husband were shocked
“There was no apparent history of diabetes on either side of the family, and there were no answers as to why she had it. The only treatment available was, and still is, daily injections of insulin for life.
"Balancing insulin with food so that her glucose levels were neither too low (causing her to become unconscious if she wasn’t given something sugary) nor too high (too much glucose in the body for too long can be fatal) seemed so complicated. How could she possibly lead a normal life?
"With the help of our diabetes specialist nurse, Suzy was taught how to inject herself (and her teddy bear!) using a device that looked like a fountain pen and had a small electronic meter to test the glucose levels in her blood from a finger prick sample.
"In fact, things carried on pretty much as normal and, back then, she was very open about having the condition, quite proud of it, in a way. So long as there was a bit of forward planning, she could go to sleepovers, school trips, parties and so on. Even puberty caused no problems unless you count the mood swings typical of any teenager.
"But when Suzy started university (she stayed in London but went into a flat share) things changed. Away from the comfort zone of her old school friends, she didn’t want anyone to know she had diabetes because she didn’t want to be 'different'.
"We clashed constantly when I asked her about her glucose levels, whether she was eating sensibly (bearing in mind that junk food is the student’s staple diet) or quizzing her about drink, drugs, sex and so on.
"I’m pretty sure that none of her uni friends knew that she had diabetes and there was a real worry that if she didn’t eat enough and therefore became ‘hypo’ (low glucose levels), no one would know to give her something sugary to bring the levels back up.
"For this reason, she made sure that she never allowed her levels to get anywhere near a hypo and therefore constantly kept them too high (which can lead to later complications).
"She was an adult, so none of this was my business, as she kept reminding me. As her mother, how could I not be concerned? But I knew that I had to let go and get off her back.
"Things improved once Suzy started work. Having complained constantly about having to go for her crucial hospital check-ups, she found a clinic that suited her and started eating more sensibly.
"Although diabetes is not a topic of conversation she wishes to dwell on, these days I can now ask her how she’s doing without provoking a row. Our relationship, which was always close, has survived and, I’d say, is now closer than ever.
"Suzy would be the first to say that she lives a fulfilling, active and yes, completely ‘normal’ life, which includes a job she loves, plenty of friends, a steady relationship, driving, clubbing and snowboarding. Virtually nothing is off-limits.
"I’m sure that she still resents her diabetes, who wouldn’t? But I like to think that she's the strong character she has become because of it, not despite it.”
'After the shock, I took control'
Cricket star Wasim Akram’s glittering career was coloured with a series of personal battles including numerous injuries, clearing his name after match-fixing allegations and, possibly his greatest challenge, coping with type 1 diabetes
Wasim Akram, described as the Prince of Pakistan, was the natural successor to his great mentor Imran Khan. His skill with a cricket ball defied the laws of physics and when he retired last year after 20 years in the game, he left an indelible mark as a supreme all-rounder and the best one-day international player in history.
Wasim was 30 when he was diagnosed with insulin-dependent diabetes.
“I remember what a shock it was because I was a healthy sportsman with no history of diabetes in my family whatsoever, so I didn’t expect it at all,” he recalls. “It seemed strange that it happened to me when I was 30, but it was a very stressful time and doctors said that can trigger it.”
"It was the match-fixing allegations that lay at the root of his stress. In a country fanatical about its national sport, Wasim was seen as a villain and his whole family felt the pressure as a result. He was eventually cleared, but he remembers that time vividly.
“I had lost 8kg in a little over two months, but I put it down to hard training, drinking lots of water and sleeping a lot. I actually faced the West Indies in that condition. My father and my wife insisted I go to the doctor and he found my sugar level was sky-high,” says Wasim.
“I felt down at first but my wife, who qualified as a psychiatrist at UCL, helped me come to terms with it. I would advise anyone with diabetes to think positive – adjust your lifestyle to fight it. Keeping fit and eating a very balanced diet have been crucial to keeping it under control and allowing me to continue playing. If you have control of your body, you're in control of diabetes. It's important that you check blood sugar levels before meals and go for regular check-ups.”
Like many people with diabetes, Wasim has had to adapt his routine and learn to inject insulin, which he takes three times a day. He also takes herbal supplements. His retirement last year has given him the opportunity to relax and spend more time with his family.
“Obviously I'm resting a bit more at home now rather than living out of a suitcase. I still like to keep fit by playing with my kids and I play a lot of golf. I’m 38 now so I've been managing what I eat for almost eight years and it’s become part of my daily routine.”
Wasim knows his responsibilities as a parent and is doing all he can to keep his two children healthy. “It’s important that parents help their kids eat well and keep active, rather than watching TV and eating sweets.”
'I thought everyone at school would think I was shooting up'
Chandler Bennett, 17, was diagnosed with type 1 diabetes in October 2004. She maintains a positive attitude to life, and has learned to manage it by calculating the carbohydrates in her food and taking insulin.
"When I was first diagnosed, my first thought was, 'Oh my God, why me?' I used to be terrified of injections, so that whole side of it completely scared me.
"I was self-conscious at first. I didn't want to inject myself in front of everyone. I thought it was going to be embarrassing and everyone at school would think I was shooting up in the middle of lunch.
"If I didn’t medicate, my blood sugars would rise and I would start to feel dizzy. If I then continued not taking insulin, I would get ill, probably throw up and then eventually die.
"When you have type 1 diabetes you have to calculate the carbohydrates in your meals. A piece of toast is 20g of carbohydrates and I have one unit of insulin for every time I eat 20g of carbohydrates.
"It was a foreign idea. I hadn't ever considered food as something to be calculated. Sometimes school lunch can be a bit difficult because you don't really know what's in everything.
"It was a bit tricky and I made mistakes at first. You have to expect that, I suppose. However, you get into a pattern and everything becomes second nature.
"It definitely affects my sports. I have to check my blood sugars more frequently when I'm playing sport. I do quite competitive sprinting, which is difficult because adrenaline in sport brings your blood sugars up rapidly.
"A few months after I was diagnosed I moved on to the insulin pump. It was a good change for me. It definitely gives me a lot more flexibility. It's like a bigger injection, but once every three days, and it pumps in insulin throughout the day.
"Sometimes I get little red spots on my body, which makes me a little self-conscious when I'm going to the beach. I don't really like to wear bikinis.
"It was definitely a bit of a nightmare at first, but I think if you approach diabetes with a positive attitude and more of an 'I can do this. How will I do it?' instead of a 'This is a nightmare. Why did I get this?', it just becomes a part of who you are.
"Everyone can control diabetes; you just have to put in the effort. It's worth it, because when it's controlled, you feel like you're just like everybody else."
'I feel blessed that I’ve had this operation and it’s worked well'
Former diabetic Ivy Ashworth-Crees, 59, talks about how much better her life is since her double kidney and pancreas transplant.
"About 32 years ago I was diagnosed with diabetes and had to go on insulin injections four times a day. I also had to work very hard on my diet to make sure I didn’t eat too much sweet food.
"After about 25 years I got kidney failure, and in 2003 I had to go on kidney dialysis. The dialysis was very uncomfortable. It was a drain, having to do it four times a day, as well as having the diabetes injections four times a day. I felt like my life was on hold.
"I was on kidney dialysis for two years when they put me on the list to have a kidney transplant. The surgeon suggested that I could probably benefit from a kidney and a pancreas transplant, which meant I wouldn’t be a diabetic anymore.
"When I got the phone call to say that I was going to Manchester for the transplant, I was absolutely hysterical. I was a big bag of emotions – both thrilled and terrified.
"When I came round after the operation, I was in intensive care. I stayed there for about three or four days, then they took me to the main ward.
"The most difficult part was getting out of bed, on to my feet, and starting to walk. They walked me up and down the ward for weeks until my legs got strong enough. That was very, very difficult - the pain was very bad. But it’s all been worth it.
"The doctor asked me to try and reduce my weight, so I joined the gym. I enjoy swimming - I think it’s helping me to keep a bit more active. The only problem is that I can’t walk too far.
"It’s very, very important that I take the immunosuppressant drugs. If I don’t take them, the kidney and pancreas could reject. I have to take them for the rest of my life.
"My life’s changed such a lot. I now take it for granted that I can eat what I want, including chocolates! I’m back at work, I don’t have an injection after my meals, I don’t have to rush home for dialysis and my kidneys and pancreas are working well.
"I feel very blessed actually – that I’ve been through this operation and it’s worked very well."
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