Preventing Diabetes Presentation:
9th September 2015 at Manor View Practice
This presentation was kindly given by Sharon Carter (DSN) – Diabetic Nurse at Watford
General Hospital. It was a very informative talk and we are pleased that Sharon has
approved this report for our Web-site. We have included some of the questions (Q) &
answers (A) which were covered during the evening.
Did you know that 18% of Patients in Watford Hospital have diabetes?
Are you aware that one in five diabetics does not even know they have it?
1.WHAT IS DIABETES?
It is the inability to control the amount of glucose (sugar) in the blood.
It may be because you have a lack of insulin (Type I Diabetes) or your body may not use
your insulin effectively (Type II Diabetes)
Type I – There are usually antibodies to the β (beta) cells in the pancreas – which is the
organ in your body where insulin is made.
Type II - Your body shows resistance to insulin – your pancreas may have been ‘worked’ to
exhaustion so it produces insufficient insulin to collect and process the glucose in your
blood.
If you have excess sugar in your blood, it will be excreted through the kidneys, your urine
will become loaded with the glucose which can then be measured with a dip stick.
2.WHAT ARE THE SYMPTOMS OF DIABETES?
Tiredness/ thirst/ going to the loo a lot to pee.
Tiredness – glucose is not in the cells
Thirsty – you pee a lot = dehydration= thirst.
Weight loss,
Genital irritation, UTI’s (Urinary tract infections)
Blurred vision – sugar settles in the lens of the eye. If you reduce blood sugar, the vision
should improve.
3.IS THERE ANYTHING YOU CAN DO TO PREVENT GETTING DIABETES?
Type I diabetes – NO - because this is an auto-immune disease lifestyle cannot affect the
cause of the disease, although a healthy lifestyle should be adopted to maintain the best
health possible.
Type II diabetes - YES - it often has a genetic link and will appear in your 40’s.
Weight, body fat, exercise and general lifestyle will make a huge contribution to your
chances of developing diabetes.
If the appearance is sudden and severe the person must be treated with insulin.
Tests will be taken to determine which type of diabetes you have.
Most people will have type II (80- 90% diabetics).
Diet is very important.Exercise – is very important and can be twice as effective as any
tablets. ANY EXERCISE!
Preferably 1 hour a day and it is better if the heart rate is increased.
It makes your cells more sensitive to insulin.
Gestational diabetes – YES – This is when a woman develops diabetes during pregnancy.
It is usually temporary.
She will have a blood test 6 weeks after baby is born, but there is an increased risk of
diabetes later in life.
Risk can be measured by the size of the tummy
Q: Why is tummy size important?
A: Tummy fat works differently from other body fat.
Q: Does gestational diabetes affect the baby?
A: There is an increased risk of diabetes in later life + CHD (coronary heart disease).
Sugar also affects the baby’s insulin, which produces increased body fat and is unhealthy for
baby.
That is why there will be regular tests during pregnancy, and two week appointments at the
clinic.
4.WHAT ARE THE RISK FACTORS FOR DEVELOPING TYPE II DIABETES?
Type II – if your tummy measures more than 90cm (about 36”)
Measure half way between your hip bone and your rib to get the correct measurement.
If there is a family history of Type II Diabetes.
If there is a history of Gestational Diabetes (If your mother had diabetes whilst pregnant you
are 6 x more likely to get it.)
If you have a high BMI/Waist circumference:
Your BMI is worked out by dividing your weight (in kg) by your height (in metres) squared.
That number is then divided by your waist measurement. If that sounds very complicated,
don’t worry, your doctor or nurse can do it for you. The number should be less than 25.
(Audience Comment: older men often find their chest has slipped down to their waist!)
Your ethnicity – you are more likely to develop Type II Diabetes if you are of Afro-Caribbean
or Asian descent.
Lack of physical activity!
5.CAN I REDUCE THE RISKS?
Yes Keep your BMI below 25.
Keep your waist below 90cm.
Exercise five times a week – for at least 30 minutes – anything including housework,
dancing, walking and gardening. – just move.
Q: Does shopping count as exercise?
A:Yes if you park a distance away from the shops and if you have to walk for 15 minutes
quite quickly.
Eat “Low GI” foods. These are foods that take a while to break down in your body like
porridge for breakfast, whole grains etc.
Reduce the amount of pre-processed foods, snacks, sweets, chocolates, cakes etc. that you
eat.
Reduce the amount of fat and sugar that you eat.
*Look up the Diabetes UK website for more information*
6.HOW DO YOU DIAGNOSE DIABETES?
There are a number of different ways:
1. Symptoms, we listed these in Item no 2.
2. Blood tests (Glucose Tolerance Tests, not finger prick) – GTT is measured with you
drinking a known amount of glucose, then your blood is checked 2 hours later.
If this measures between 7.8 – 11 you are considered to have impaired GTT (you
aren’t handling glucose very well). There is a risk of IHD (Ischaemic Heart Disease or
not enough blood going to the heart) and a very high risk of developing diabetes.
If your measurement is more than 11 it is a confirmation of diabetes.
3. Venous plasma Glucose (fasting number should be less than 7,
If you are not fasting it should be less than 11)
4. Hba1c Test: This measures how much sugar sticks to your red blood cells and will tell
the doctor what your average blood sugar has been for the past 2 – 3 months. This
is not routinely ordered for initial diagnosis.
5. You can print off the Risk Factor Score from Diabetes UK web site & bring it to
doctor.
Q:Why aren’t routine tests used for everyone?
A:The tests only show how you are now, not what may happen next month. Some of the
tests are very expensive, that is why they are done according to symptoms etc.
Note - Sometimes stress can increase Blood Glucose.
7.WHAT ARE THE COMPLICATIONS OF DIABETES:
Because sugar is sticky it can clog up your blood vessels – affect your kidneys (which have
very tiny blood vessels) and cause inflammation and leaky kidneys (nephropathy).
Similarly blood vessels in the eye can get affected (retinopathy) – caused by high blood
sugar and high blood pressure. New blood vessels may be formed which can then become
leaky and cause a black spot and reduced vision. This is the biggest cause of blindness .
The longer you have diabetes, the higher the risk.
Q:Why are some patients referred to a doctor by opticians?
A:Opticians can easily examine the back of the eye. If something abnormal is seen you
should be referred to a doctor to eliminate the possibility of Diabetes and Diabetic
Retinopathy.
CHD/Stroke:
Caused by blocked blood vessels.
Diabetic foot problems:
Feet need a good blood supply and well functioning nerves. High sugar damages the nerves
– you may not feel your feet, any sores or ulcers or rubbing, which can cause problems. This
is why your feet should be checked regularly.
Diabetic Keto Acidosis
Indicates very, very high blood sugar – you may smell ‘pear-drops’ or ‘acetone’ on the
breath. Can lead to coma.
Erectile dysfunction – again caused by damage to blood vessels and nerves.
8. ARE YOU AT HIGHER RISK IF YOU ARE TAKING INSULIN?
No – if your blood sugar is well controlled.
9. HOW TO PREVENT COMPLICATIONS:
Good blood sugar control.
Early detection of Type II Diabetes.
Good diet.
Good Blood Pressure control.
MOT every year, including cholesterol.
Yearly eye check
No smoking (Atherosclerosis narrows blood vessels).
Regular foot care.
10. IMPORTANT: SEE ABOVE
Use the Risk Score - Weight – Height – Waist circumference.
You can access this on: www.riskscore.diabetes.org.uk
Q:
What first aid should I know for a HYPO (low blood sugar) or HYPER (high blood sugar).
A:If the person is unconscious, leave him alone and call an ambulance 999.
If the person is conscious ask them.
Paediatric advice is different: Low blood sugar (HYPO) may leave the child shaky, sweaty,
pale and incoherent. He or she may not be aware. If you have the means do a finger prick
test. If it is low, give glucose.
If it is high (see above for pear drop smell/acetone smell on breath.) Again call 999.
Q Re meds: What happens if you are poorly with the medication your doctor gives you?
A:The Doctor can change your medications. Note that it can take up to 2 months to get
used to it (eg metformin).
We thanked Sharon for all the information and for answering all our questions.
JoanM on behalf of MVPPG