Diabetes Part 2 – Diagnosis and treatment of diabetes

At the end of the first article we mentioned the symptoms of diabetes which we’ll re-cap and we’ll then  go on to talk about how to diagnose diabetes in the lab, treat and even cure diabetes in some cases…

What are the symptoms of diabetes?

Diabetes can present in many ways. However, there are some common symptoms, including:

  • Feeling very thirsty
  • Urinating more often
  • Losing weight
  • Feeling tired
  • Frequent thrush infections/itchiness around the penis or vagina
  • Blurred vision
  • Tingling/prickling sensation in the skin

How is diabetes diagnosed?

Diabetes is usually diagnosed by a test called the HbA1C test. This is a blood test which indicates a person’s average blood sugar level over the past 2-3 months.

In some cases, this test is not appropriate (e.g. in pregnancy), or if the results are not clear, there are other blood tests which can detect how much sugar is in the blood, and thus indicate whether someone has diabetes. These tests include:

  • A fasting blood sugar test. This is where blood sugar is tested after a period of not eating overnight.
  • Oral Glucose Tolerance Test. This is where a person does not eat overnight, and their blood sugar is measured. Subsequently, they drink a sugary drink, and their blood sugars are measured periodically, to see how their body handles the sugar they have taken in.

How is diabetes managed?

Treatment for diabetes is designed to maintain blood sugar at as normal a level as possible. There are a variety of ways to do this. They can be broadly split into two categories: lifestyle changes and medication.

Lifestyle Management

Lifestyle changes, such as eating a healthy diet and taking regular exercise, are important for both types of diabetes. Medication is much less likely to be effective if a person has a poor diet or is overweight, and medication is not on its own, the most effective way to treat diabetes.

The NHS and Public Health England recommend that people with diabetes follow a diet that is:

  • Low in sugar
  • Low in saturated fat
  • High in starchy carbohydrate
  • High in fibre

There has been a lot of controversy in the medical profession including amongst diabetic experts, dietitians, nutritional therapists and doctors as to the right diet to manage diabetes. The Doctor Service and this article cannot provide specific advice, and we recommend that if you want further dietary advice that you speak to a health professional in person regarding this.

When someone is diagnosed with diabetes within the NHS, they are usually referred to a full day course known as DESMOND, which helps to educate patients on what diabetes is, and how this can be managed through lifestyle factors and medication. Some patients may also be referred for further sessions with a dietitian to help manage their diet.

Additionally, taking regular exercise is important in the management of diabetes. It not only helps to control weight, but also reduces the risk of long term health problems commonly associated with diabetes, such as heart disease. We recommend at least 150 minutes per week (2½ hours) which increses your heart rate, and trying to vary this between between weight bearing (resistance) exercise and cardio exercise (e.g. running).

Diet and exercise is particularly helpful for people with type 2 diabetes. Weight loss can significantly improve cell sensitivity to insulin in some people, effectively reversing the abnormalities of type 2 diabetes. It’s important to know, especially in those who are at very high risk of developing diabetes, or have just been diagnosed with diabetes, it is possible to reverse diabetes so you do not need to take medication!

Medication Options

While diet and exercise are important for both type 1 and type 2 diabetes, the medications for each type are slightly different.

Type 1 diabetes occurs because the body does not produce enough insulin. Therefore, it is managed by taking extra insulin that the body does not produce. Insulin treatment can come in several forms. It can be long or rapid acting, and can be delivered by injections or an insulin pump.

Type 2 diabetes occurs because the body does not produce enough insulin, or because the body does not respond effectively to insulin. Therefore, tablets can be used to stimulate more insulin production, or to make the insulin the body produces more effective. If these don’t work then providing the body with more insulin is still an option.

Metformin is the most common medication used to treat type 2 diabetes. It works in two ways: it helps make cells more sensitive to insulin, and it also reduces the amount of glucose (sugar) the liver releases into the body. There are a variety of other medications that can be used in different combinations as a person’s diabetes progresses, with medications such as Gliclazide, Sitagliptin or Dapaglifozin. These all work in different ways. Doctors will work with the person with diabetes to decide on the best combination.

What are the potential health consequences of diabetes?

Diabetes can cause long term health consequences, particularly if sugar levels are not well managed. This is because chronic high blood sugars damage the small blood vessels and nerves in the body. In diabetes, this most commonly affects the cardiovascular system, eyes and the feet. This means people with diabetes, especially poorly controlled diabetics are at increased risk of kidney disease, eye disease, strokes and heart attacks.

However health consequences can be minimised in several ways:

  • Blood sugar monitoring and optimisation: regular blood tests of your average sugar level (Hba1c) can keep an eye on your blood sugar, and allow the health professionals managing your diabetes to optimise your treatment.
  • Foot care and Prevention: regularly checking the feet for cuts, grazes and blisters is important, as having diabetes means these are more likely to get infected or develop into ulcers.
  • Other Regular Check-ups: regularly having foot, eye and blood sugar checks with the GP or diabetes team ensures that appropriate professionals have a good overall sense of how effectively a person’s diabetes is being managed. This allows for adaptation of the treatment plan or increased support as required.

What is life like with diabetes?

Diabetes is a lifelong condition which may pose extra challenges, but you should be able to live a normal life. However, it can be managed with good self-care, medication and support from healthcare professionals.

You can find more information on various illness and a variety of treatments available on The Doctor Service website.

Further information:

Diabetes UK: https://www.diabetes.org.uk/home

Diabetes Research and Wellness Foundation: https://www.drwf.org.uk/

BMJ (2017). BMJ Best Practice. [online] Available at: http://bestpractice.bmj.com/ [Accessed 6 Jan. 2018].

Diabetes Research & Wellness Foundation. (2017). Diabetes Research & Wellness Foundation. [online] Available at: https://www.drwf.org.uk/ [Accessed 6 Jan. 2018].

Diabetes UK. (2017). Diabetes UK – Know diabetes. Fight diabetes.. [online] Available at: https://www.diabetes.org.uk/home [Accessed 6 Jan. 2018].

Kumar, P. and Clark, M. (2017). Kumar & Clark’s clinical medicine. 9th ed. Amsterdam: Elsevier.

Lazar, M. (2005). How Obesity Causes Diabetes: Not a Tall Tale. Science, 307(5708), pp.373-375.

Leong, K. and Wilding, J. (1999). Obesity and diabetes. Best Practice & Research Clinical Endocrinology & Metabolism, 13(2).

Lim, E., Hollingsworth, K., Aribisala, B., Chen, M., Mathers, J. and Taylor, R. (2011). Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia, 54(10), pp.2506-2514.

NICE (2018). Diabetes | Guidance and guideline topic | NICE. [online] Available at: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal–nutritional-and-metabolic-conditions/diabetes [Accessed 6 Jan. 2018].

Petersen, K., Dufour, S., Befroy, D., Lehrke, M., Hendler, R. and Shulman, G. (2005). Reversal of Nonalcoholic Hepatic Steatosis, Hepatic Insulin Resistance, and Hyperglycemia by Moderate Weight Reduction in Patients With Type 2 Diabetes. Diabetes, 54(3), pp.603-608.

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