Managing Diabetes

Wait, wait, wait, before we begin...are we talking Type 1 or Type 2? Because they're different things, right? Kinda but not really, diabetes is the condition where your body does not produce enough insulin for your needs. The types can be described as:

Type 1: This is the type that needs insulin injections to manage it.
Type 2: This is the type that is linked to poor diet and low exercise levels.

So...what's insulin then? Insulin is a hormone that regulates the body's use and storage of fat and glucose (sugar). Most of the body's cells need glucose to work properly. It works by telling the liver, muscle and fat cells to take glucose from the blood.

Type 1 diabetes means the body does not produce enough insulin to regulate your glucose levels. Without enough insulin the body uses different sources of energy – these sources (ketones) can lead to the dangerous condition of ketoacidosis (your body fat has been used for energy instead of blood glucose – it can turn your blood acidic and requires immediate medical attention if you think you may have it).

Type 2 diabetes means the body does not respond to insulin as well as it once did. It is sometimes called 'Insulin Resistance'. Since it doesn't work as well, the body responds by producing more to compensate. If left unchecked, the cells that produce insulin wear out. Later stages of Type 2 may also need insulin injections as a result.

Both types of diabetes can be diagnosed through blood/urine tests, though diabetes management methods differ.
 

Diabetes – Type 1

Type 1 diabetes starts fairly quickly. You can be diagnosed as a Type 1 as early as childhood. Type 1 diabetes symptoms include:
 

• feeling very thirsty

• peeing more than normal, particularly at night

• feeling very tired

• losing weight without trying

• thrush that keeps coming back

• blurred vision

• cuts and grazes that are slow to heal

Managing Diabetes – Type 1

Type 1 diabetes can be managed through regular blood glucose tests (your diabetes nurse will show you how to do this – there are loads of glucose monitors available in pharmacies and online). Check your level, apply the amount of insulin you need, then go and live your life. You will have to attend some courses on diabetes when you are first diagnosed – just so that you know how to look after yourself.

Management of type 1 diabetes relies on you constantly monitoring your blood glucose levels (and potentially your ketone levels – depending on your glucose monitor and your diabetes team's advice).
 

For more information see the NHS website on Type 1 Diabetes here.

Diabetes – Type 2

Type 2 diabetes tends to develop later in life, at one point it was mainly over 40's that developed it but there is a growing trend of younger diagnoses. Type 2 diabetes symptoms include:
 

• Peeing more than usual, particularly at night

• Feeling thirsty all the time

• Feeling very tired

• Losing weight without trying to

• Itching around your penis or vagina, or repeatedly getting thrush

• Cuts or wounds taking longer to heal

• Blurred vision

Managing Diabetes – Type 2

Type 2 diabetes (often known as Insulin Resistance) can be managed through diet, activity changes and by medication (not usually insulin in early years). It's less likely that you will need a blood glucose monitor initially (great if you're squeamish) and more likely that you can live simply by managing your diabetes with diet and exercise alone. Type 2 diabetics can get Hypoglycaemia and Hyperglycaemia same as Type 1 diabetics – see below section on those for details. You will have to attend some courses on diabetes when you are first diagnosed – just so that you know how to look after yourself.

Management of type 2 diabetes generally relies on a good diet and plenty of exercise to non-medically lower your blood glucose level.

Diet: Luckily for you, you won't have to cut certain food groups like carbs out completely (WOOHOO!), but you do have to limit them a bit (aww). You should limit sugars, fats and salts in your diet, no more snacking between meals and ensure you do not skip any meals (skipping meals will make you produce even more insulin to get the energy you need). A wide range of food groups, fruit, veg, protein, dairy, even carbohydrates are all part of a healthy balanced diet and that is what you are aiming for. You may be referred to a dietician to help you with this if you're having trouble.

Exercise: Physical exercise helps lower your blood sugar level. Your diabetes the team will recommend how much exercise you need specifically, but the average amount advised is 2.5 hours per week. But REJOICE! Exercise does not mean you have to go jogging or join a gym, exercise just means 'anything that raises your heart rate' so that includes walking, climbing stairs, doing more strenuous housework, gardening, golf, swimming or dancing, this is a great time to start that new hobby you've been meaning to try, get a friend or family member involved too for company and fun times.

Management of type 2 diabetes relies more on lifestyle changes, especially at early stages. Some people have found they can reverse their diabetes symptoms by going on a low-carb or low-calorie diet but you should always talk to your diabetes team or dietician first BEFORE starting something like that, as low-calorie diets can make Hypoglycemia more likely.

Alphabet Strategy

Many doctors advise the 'Alphabet Strategy' for diabetes management for either type. The Alphabet Strategy (or ABCDEFG Plan) focuses on 7 key areas to help manage your diabetes:
 

Advice – Stop smoking, aim for 5 portions of fruit and veg per day, exercise regularly, lose weight, plan journeys around your insulin doses and meals and don't drink too much.

Blood Pressure – High blood pressure can increase the chances of complications check regularly, reduce your salt intake and be sure to take your medication regularly.

Cholesterol – A fat in the blood that can cause blockages leading to heart problems and strokes. A healthy diet, exercise, and medication can reduce cholesterol.

Diabetes Control – A good glucose target is 4-7. Monitor regularly, take your medication regularly as prescribed.

Eyes – Diabetes can damage your eyes, get tested yearly to prevent blindness.

Feet – Diabetes can cause numb/cold feet and foot ulcers, check them daily for injuries or blisters as you may not feel them and they could get infected – treat immediately.

Guardian Drugs – Recommended by your diabetes team – aspirin/ACE inhibitors/statins – to reduce your risk of heart attacks, stroke, eye or kidney problems – take as prescribed.

Working together, these 7 form a practical way to look after your health while living with diabetes.

What happens if you don't look after yourself?

If they don't look after themselves properly diabetics of both types run the risk of Hypoglycemia (blood glucose levels too low) or Hyperglycaemia (blood glucose levels too high).
Hypoglycemia (or Hypo) can start very quickly after you: delay meals have not eating enough carbohydrates in your last meal, do lots of exercises without having the right amount of carbohydrates or reducing your insulin dose, take too much insulin, drink alcohol on an empty stomach.

Symptoms of a Hypo: sweating, being anxious or irritable, feeling hungry, difficulty concentrating, blurred sight, clumsiness, slurred speech, confusion, trembling, feeling shaky and loss of consciousness (fainting). The best treatment you can give yourself? A small handful of Jelly Babies! Then wait 10 minutes, check your blood glucose again, then more sweets if you need them.

Hyperglycaemia (or Hyper) can lead to ketoacidosis, a potentially life-threatening condition that may require hospitalisation to treat. Hypers can be triggered by: being stressed, being unwell, being less active, not having enough insulin for the carbohydrate you have eaten. Treatment is: take the medication your doctors advised for this (Insulin or insulin-alternate)
Symptoms of a Hyper: feel very thirsty, pee more than normal, feel tired all the time, lose weight without trying, have blurred vision, dry mouth, confusion, abdominal pain, weakness and having fruity-smelling breath.

From the outside a Hypo can look a little like you're drunk. Make sure your family and work colleagues (especially the first aider and those you work with most often) know the symptoms as well. Hypers are just as dangerous as Hypos, both can leave you in comas and both have the potential to cause serious (even fatal) issues.

Management of diabetes, of either type, as with the management of any long term condition requires regular medical check-ups, drug reviews and blood glucose tests. It needs you to look after yourself and pay attention to what your body needs. Your diabetes team will be able to help you and if you need further support, there are 1001 tips on 'how to manage diabetes' online on sites such as www.diabetes.co.uk and www.diabetes.org.uk.