1. health and fitness
2. disease
3. diabetes

Type 2
DIABETES
TREATMENT
food
Lifestyle
WHAT YOU
NEED TO KNOW
Working in partnership with
PACK
SOME
PEACE
OF MIND...
Diabetes UK Insurance Services provides comprehensive travel insurance,
covering pre-existing medical conditions, with no upper age limit on single
trip policies. What’s more, Diabetes UK receives a donation for every policy
sold, at no extra cost to you.
So what are you waiting for? Choose to protect yourself and your loved
ones with the help of Diabetes UK Insurance Services.
•
•
•
•
•
•
•
•
TRAVEL INSURANCE
LIFE ASSURANCE
HOME INSURANCE
MOTOR INSURANCE
RETIREMENT
ESTATE PLANNING
FUNERAL PLANNING
HEALTH CASH PLAN
Call 0800 731 7431
for a quote or more information. Quoting: TT2.
Alternatively, visit www.diabetes.org.uk/services
now for more information and a 10% discount off your
travel insurance policy.
Diabetes UK Insurance Services is a trading name of Heath Lambert Limited which is authorised and regulated
by the Financial Services Authority. Registered Office: 9 Alie Street, London E1 8DE. Registered No.: 1199129
England & Wales. www.gallagherheath.com
Gallagher Risk & Reward Limited is authorised and regulated by the Financial Services Authority. Registered Office:
9 Alie Street, London, E1 8DE. Registered No. 3265272 England & Wales. www.riskandreward.com
Funeral plan is provided by Dignity Pre Arrangement Limited. A company registered in England No.: 1862158. VAT registered
No.: 486 6081 14. 4 King Edwards Court, King Edwards Square, Sutton Coldfield, West Midlands B73 6AP Telephone
No.: 0121 354 1557. Fax No.: 0121 355 8081. Part of Dignity plc. A British company. Registered with the Funeral Planning Authority.
Key Retirement Solutions Limited. Registered in England No. 2457440. Registered Office: Harbour House, Portway, Preston,
Lancashire, PR2 2PR. Telephone 08451 655955 Facsimile 0845 12 555 13. Key Retirement Solutions is authorised and regulated
by the Financial Services Authority.
All benefits payable are subject to BHSF Limited policy terms: Copies available on request. BHSF Limited is authorised
and regulated by the Financial Services Authority.
SD3890_A/18032013
Testing
Hypos & hypers
14
Education
Eating in
Eating out
46
30
18
Welcome
Welcome to What You Need to Know – Type 2
Diabetes. This is an introductory guide for adults
who’ve recently been diagnosed with Type 2
diabetes. It also serves as a handy refresher for
those who have had the condition for some time.
Following diagnosis, it’s perfectly understandable
that you may be experiencing a wide range of
emotions. You may feel upset, angry, confused
and even guilty. You may be asking yourself the
question, ‘Why me?’ – and wondering how you
will cope.
This guide will answer a lot of your questions and
address your doubts and concerns by giving you
the facts. It takes you through diabetes care and
living your day-to-day life – from work and illness,
to socialising and travel. It also sheds light on some
complications that you need to be aware of and the
steps you can take to prevent them. It will also tell
you where you need to go for more information.
Plus, there’s lots of information about how
Diabetes UK can support you as you continue
to live your life to the full.
44
what’s
inside...
INTRODUCTION
5 Debunking the myths
6 What is diabetes?
DIABETES CARE
8Medications
12 Moving to insulin
14Testing
18 Hypos & hypers
22 Long-term testing
24 The care to expect
30Education
31 Health information online
FOOD
32 A healthy balance
34 Top tips for eating well
36Carbohydrates
40 Food labelling
44 Eating in
46 Eating out
50Alcohol
52 Religious fasting
53 Questions & answers
2013 Type 2 diabetes
3
Physical activityPregnancy
Work
62
LIVING WITH DIABETES
55 Weight management
60 Calorie swaps
62 Physical activity
66 Accepting diagnosis
68 Telling people
70 Love life
72 Contraception
74 Pregnancy & labour
78 Illness & infections
80 Work & discrimination
82Travel
84Festivals
86Driving
88 Smoking & drugs
ARTICLES & ADVERTISEMENTS
Products and services advertised in this guide are not necessarily
recommended by Diabetes UK. Although the utmost care is taken to ensure
products and services advertised are accurately represented, it is only
possible to thoroughly check specialist diabetes equipment. Please exercise
your own discretion about whether or not an item or service advertised is
likely to help you personally and, where appropriate, take professional advice
from your medical advisor. Please note also that prices are applicable only to
British buyers and may vary for overseas purchases.
Diabetes UK policy statements are always clearly identified as such.
©Diabetes UK 2013 A charity registered in England and Wales (no. 215199)
and in Scotland (no. SC039136).
With thanks to all the contributors and advisors, and the volunteers
who participated in photoshoots.
Type 2 diabetes 2013
Driving
86
80
74
4
Travel
82
complications
90Cardiovascular disease (CVD)
92Retinopathy
94Neuropathy
96Nephropathy
FURTHER INFORMATION
98 About Diabetes UK
debunking the myths
INTRODUCTION
diabetes
my ths
Myth: Eating
lots of sugar
causes diabetes
Having lots of sugar has no
direct effect on your risk of
diabetes. Sugary foods are
high in calories which can mean
taking in more calories (energy)
than your body needs, leading
to weight gain. This increases
the risk of Type 2 diabetes.
Myth: It’s not
safe to drive
if you have
diabetes
Myth: People
with diabetes
cannot have
sugar
Having diabetes doesn’t
mean having to have a
sugar-free diet. People
with diabetes should
follow a healthy, balanced
diet low in fat, salt and
sugar, but they should still
be able to enjoy a wide
variety of foods, including
some with sugar.
If people with diabetes are
responsible and have good
control of their blood glucose
levels they are just as safe on
the roads as everyone else.
Nevertheless, the myth persists
that people with diabetes are
unsafe to drive.
i F
or more on driving,
see p86.
Myth: People
with diabetes
should eat
‘diabetic’ foods
Myth: People
with diabetes
can’t play sport
People with diabetes are
encouraged to exercise
as part of a healthy
lifestyle. Keeping active
can help reduce the risk of
complications such as heart
disease. Sir Steve Redgrave,
Olympic gold medal-winning
rower, is an example of
someone who has achieved
great sporting achievements
while living with diabetes.
i For more on exercise,
see p62.
‘Diabetic’ labelling tends to be used
on sweets, chocolate, biscuits and
similar foods that are generally
high-calorie and often have
lots of fat. Diabetes UK doesn’t
recommend ‘diabetic’ foods for
people with diabetes because these
foods still affect blood glucose
levels, are expensive and can cause
diarrhoea. If people want to treat
themselves occasionally then they
should go for the real thing.
i F
or more on food, see p32.
2013 Type 2 diabetes
5
Introduction
what is diabetes?
Type 2 diabetes explained
You may hear a lot of different and sometimes conflicting information about
diabetes and how it affects people, which can be confusing. It’s important to
get the right information from a trusted source, so here are some of the facts
gullet
liver
stomach
pancreas
6
Type 2 diabetes 2013
What is diabetes?
Diabetes is a condition where
your body can’t produce insulin,
it doesn’t produce enough,
or where your insulin doesn’t work
properly. If you don’t have the
right amount of insulin, or if your
insulin isn’t doing its job properly,
you can become very ill.
What is insulin?
It is a hormone that helps your
body use the glucose in your
blood to give you energy. Insulin
is made by an organ called the
pancreas, which lies just behind
the stomach. It acts as the ‘key’
that ‘unlocks’ the body’s cells to
let glucose in, which is then
converted into energy.
Where does glucose come from?
Glucose enters the bloodstream
when we digest carbohydrate
from various kinds of food and
drink, including starchy foods (such
as bread, rice, potatoes), fruit, some
dairy products, sugar and other
sweet foods. The liver also produces
glucose. In people without diabetes,
insulin carefully controls the amount
of glucose in the blood.
What happens in someone
with Type 2 diabetes?
Type 2 diabetes develops when
what is diabetes?
the pancreas doesn’t produce
enough insulin or when the insulin
it produces doesn’t work properly
(known as insulin resistance). As
a result, glucose remains in the
bloodstream and is unable to enter
the cells where it can be converted
into energy. This is why some people
with untreated diabetes often feel
tired. The body then gets rid of the
excess glucose via the urine. This
can make you pass more urine than
usual and become dehydrated,
which may lead to extreme thirst.
What are the symptoms?
The symptoms of undiagnosed
Type 2 diabetes are the same as
those you may experience if your
blood glucose levels are higher
than normal. These may include:
• passing urine more often,
especially at night
• increased thirst
• extreme tiredness
• genital itching or
regular episodes
of thrush
• wounds and cuts
that take a long time
to heal
• blurred vision
• losing weight without trying.
What are the risk factors?
Although you already have
diabetes, you might want to
encourage your family and friends
to see if they are at risk and to look
out for the signs of Type 2 diabetes.
The earlier they take action, the
sooner they can get the right care.
People who are most at risk of
Type 2 diabetes are:
• aged over 40 years old
(or over 25 if South Asian)
• from a Black African, Caribbean
or South Asian origin
• those who have a parent,
brother or sister with diabetes
INTRODUCTION
• overweight
• women with a waistline
bigger than 80cm (31.5in)
• men with a waistline bigger
than 94cm (37in), or 90cm
(35in) for South Asian men
• those who have ever had
high blood pressure, a
heart attack or a stroke
• people taking anti-psychotic
medication to treat a
mental health condition
• women who have
polycystic ovary syndrome
or have had gestational
diabetes or had a baby
weighing more than
4.5kg (9.9lb)
• known to have pre-diabetes,
impaired glucose tolerance
or impaired fasting glucose.
The more risk factors a person
has, the greater their risk of
developing Type 2 diabetes.
How is Type 2 diabetes treated?
There are three main treatments:
• h
ealthy eating and being physically active, or
• healthy eating, being physically active and medication, or
• healthy eating, being active, medication and insulin injections.
Your diabetes healthcare team will talk to you about how to manage your diabetes. You may need
to make lifestyle changes, such as eating more healthily and being more active, and – if necessary –
losing weight. You may also need to take diabetes medication or have insulin injections – or both.
Everybody is different and it can sometimes take a while to find out what works best for your diabetes.
As Type 2 is progressive, your treatment may need to change over time – either the dose or the type
of medication. Your doctor or nurse will work with you to find the treatment that’s right for you.
Some people refer to Type 2 diabetes as ‘mild’ depending on how it is treated. Type 2 diabetes
is not mild, it is a serious medical condition that won’t go away, but with the right treatment it
shouldn’t stop you living a full life. It’s important that you understand what you need to do.
2013 Type 2 diabetes
7
Diabetes care
MEDICATIONS
your
medication
Alongside a healthy diet and physical
activity, medication may also be used
to control your diabetes
K
eeping good control of
your blood glucose levels
(as well as your blood pressure
and blood fats) is the best
way of avoiding the long-term
complications associated with
diabetes. Diabetes medications
help to lower blood glucose levels,
and they work in a number of
different ways (see overleaf).
When you are first diagnosed
with Type 2 diabetes, your doctor
may ask you to look at what you are
eating, lose weight if necessary and
be more active as a way of getting
your blood glucose levels under
control. This is because excess
weight makes the insulin you are
still producing work less effectively.
These lifestyle changes work for
some people and they are able to
control their diabetes as a result.
But others find their blood
glucose levels stay high or start
to rise again despite a period of
time where lifestyle changes were
controlling their levels. Doctors
will then add in some form of
medication. This is not used instead
of a healthy lifestyle – you still need
to eat healthily and be physically
active. For some people, even this
won’t be enough; Type 2 diabetes
is a progressive condition and more
than one type of treatment is likely
8
Type 2 diabetes 2013
to be needed over your
lifetime. Some people
who can initially keep
control with one type
of medication may, over
time, need to change
that medication or need to take
several different types, or need
to take insulin. This doesn’t mean
they have done anything wrong –
it’s just that the body needs more
help to control diabetes and keep
complications at bay. Your diabetes
healthcare team will help you decide
when (and if) your treatment needs
to change.
Which diabetes medication
is best for me?
This will depend on your own needs
and situation, so you should discuss
the types of medication available
and the ones best suited to you with
your healthcare team. Whichever
medication you are prescribed, it will
only work if you take it properly and
regularly. Make sure your doctor or
pharmacist explains how much to
take, when to take it and discusses
possible side effects with you.
Know your medication
When you’re given your prescription,
it is important to know the name of
your medication, what dose you
should take and when. Diabetes
medications are safe drugs but, like
all medication, they can have side
effects or react with other medicines
you are taking. There are several
different types of medication, which
work in slightly different ways, and
can have particular side effects. Ask
your doctor, nurse or pharmacist
about the medication you’re taking.
types of
medication
There are several different groups
(or types) of diabetes medication:
• Biguanides
• Sulphonylureas
• Alpha-glucosidase inhibitors
• Prandial glucose regulators
• Thiazolidinediones (glitazones)
• Incretin mimetics
• DPP-4 inhibitors (gliptins)
• SGLT2 inhibitors.
These groups may contain more
than one medication. Most
medicines have two different names.
One is the generic (proper) name.
The other is the brand (trade)
name given by the manufacturer.
MEDICATIONS
The important name to remember is
the generic name. If you are unsure
about whether you have the right
medication, check with your
pharmacist. If you feel you need
more information on your
medication(s) speak to your doctor,
nurse or pharmacist. The Patient
Information Leaflet (PIL) also has
more information. This is produced
by the manufacturer and is
dispensed with your medication.
combination
medication
The aim of any treatment is to keep
blood glucose levels as close to
normal as possible. As this is
individual to each person, the target
levels must be agreed between you
and your diabetes team. To stay
within your range you may need to
take a combination of tablets, such
as a sulphonylurea and metformin,
or a combination of tablets
and an injection.
diabetes care
Q& A
What if I forget to take a tablet or a dose?
You need to keep taking your tablets regularly to
keep your diabetes under control. But if you do forget
a dose, don’t double the amount when you come to
take your next dose. If it is only an hour or two since
your normal time for taking the tablet, just take it as
soon as you remember. If it’s more than a few hours
after, miss the dose out and take the next one at the
usual time. If you frequently forget to take your tablets,
discuss this with your doctor. It may be possible to
simplify your treatment.
Do I still need my medications
when I’m ill and not eating?
Yes. If you cannot eat your ordinary meals, try to
have some snacks or soup, milk or fruit juice instead.
Your doctor may suggest you test your glucose levels
at least four times a day and keep a record of your
results. If you are being sick and cannot keep
anything down, contact your GP or diabetes clinic
straight away. Read more about managing your
diabetes when you are ill on p78.
Side effects
All medication has potential side effects and you should check the information
leaflet supplied to see which side effects you might experience. Some side effects
are just temporary while your body gets used to the treatment. Remember that
you are unlikely to experience all side effects that are listed, and you may not
experience any at all. If you do, speak to your doctor as there may be another
type of diabetes medication you could try instead.
Ask your doctor for advice if you notice an adverse change in your symptoms
after moving to a new drug or any new side effects you think you have. You can
also report unwanted side effects (not already included in the patient information
leaflet) using the yellow card scheme, which is used is to collect information
from on suspected side effects. Visit www.yellowcard.mhra.gov.uk,
call 0808 100 3352 or pick up a card from your GP.
2013 Type 2 diabetes
9
Diabetes care
MEDICATIONS
Prandial glucose regulators
Examples include repaglinide and nateglinide.
Sulphonylureas
Different sulphonylureas are
available, examples include
gliclazide, glipizide and
glibenclamide.
How they work Like the sulphonylureas,
these stimulate the cells in the pancreas to
make more insulin. However, unlike the
sulphonylureas, they work very quickly but only
last for a short time. There is also a risk of
hypoglycaemia (low blood glucose levels).
How they work They stimulate
the cells in the pancreas to make
more insulin. They also help the
insulin to work more effectively.
There is a risk of hypoglycaemia
(low blood glucose levels).
When to take them They should be taken
within half an hour prior to each meal. If you
miss a meal, the dose is not required.
When to take them They are
taken once or twice a day, with
or shortly before, meals.
Biguanides
Metformin is the only biguanide used in the UK.
How it works Metformin helps stop the liver
producing new glucose and enables the
body’s insulin to carry glucose into muscle
and fat cells. It can also aid weight loss.
When to take it Metformin is usually used
as the first line of treatment, especially for
people who are overweight. Metformin is
taken two or three times a day, with a meal
– to help the insulin work at the correct time.
It is available as tablets for immediate
release (up to three times a day) or prolonged
release (usually once a day), and oral solution
and powder for immediate release.
Thiazolidinediones (glitazones)
The only one in this group
is pioglitazone.
How it works Pioglitazone helps
the body to overcome
insulin resistance, enabling it
10
Type 2 diabetes 2013
to use its own natural insulin
more effectively.
When to take them Once
or twice a day. It’s useful for
overweight people and helps
to prevent heart problems.
muscle
liver
pancreas
MEDICATIONS
diabetes care
Alpha-glucosidase inhibitors
There is only one tablet of this
type currently used in the UK,
called acarbose.
How it works It slows down
the absorption of starchy foods
from the intestine, slowing
down the rise in blood glucose
after meals.
When to take it It should be
chewed with the first mouthful
of food or swallowed whole
with a little liquid immediately
before food.
Incretin mimetics
This is a non-insulin medication
given by injection, examples include
exenatide and liraglutide.
How they work
They increase levels of hormones
called ‘incretins’. These hormones
help your body produce more insulin
as it is needed; reduce the amount of
glucose being produced by the liver
when it is not needed; reduce the rate
at which your stomach digests food
and reduce appetite.
When to take them There are three
types of incretin mimetics. The
once-daily version (Victoza) can be
given any time, but the twice-daily
(Byetta) should be given within 60
minutes of the morning and evening
meal – not after a meal. There is also a
once weekly version called Bydureon.
stomach
kidney
(located behind)
DPP-4 inhibitors (gliptins)
Examples in this group include sitagliptin,
vildagliptin and saxagliptin.
How they work They block the action of the
enzyme DPP-4, which destroys the hormone
incretin. Incretins help the body produce more
SGLT2 inhibitors
The only one in this group
is Dapagliflozin.
How it works
It works by reducing the
amount of glucose being
absorbed in the kidneys so
that it is passed out in the
urine, reducing the amount
of glucose in your blood.
When to take it
Once a day. Because of
the way it works, your
urine will test positive for
glucose while you are on
this medication. How
effective it is depends on
your kidney function. There
is a risk of genital infections
and urinary tract infections.
insulin when it is needed – and reduce levels of
glucose being produced by the liver when it is not
needed. These hormones are released throughout
the day and levels are increased at meal times.
When to take them Depending on the type, they
are taken once or twice a day with or without food.
2013 Type 2 diabetes
11
Diabetes care
Moving to insulin
Some people with
Type 2 diabetes may
find that over time
they’re taking more
than one medication,
and that insulin may
be an option. It sounds
daunting, but with time
it will become part of
your daily routine
treatment changes
I
f the medication you are taking
is no longer able to control
your diabetes on its own,
insulin may be another option.
This is because your pancreas
is becoming less efficient in
producing its own insulin.
This often happens after several
years on tablets.
This problem may be eased by
changing to a different type or a
higher dose of medication or by
taking several different types of
medication together. But, if the
problem persists, your doctor may
recommend insulin instead of, or as
well as, the tablets you’re taking.
In some cases, you might only
need insulin temporarily during an
operation, for instance, to control
blood glucose levels. Similarly, you
may be advised to use insulin if you
are pregnant or breastfeeding. In
these cases, you may be able to go
back to your original medication,
but, for some, this will no longer be
as effective and they’ll need to stay
on insulin. If you need insulin, it will
be explained what you need to do.
12
Type 2 diabetes 2013
Coping with starting insulin
You may feel like you’ve done
something wrong or you haven’t
achieved all that was expected of
you, but it’s not your fault that you
have to take insulin. Diabetes is a
progressive condition and over
time it is unlikely that the treatment
you were first given will continue to
work as well. Using insulin just
means that your body needs a bit
more help to keep you healthy and
minimise the risk of developing
complications. Most people who
change to insulin say that they feel
much fitter and wish they had
changed earlier. Talk to your diabetes
healthcare team if you are worried.
Once you’ve got over the initial
fear of injecting, you will hopefully
feel much better. Some of the
symptoms of high blood glucose
levels you may be experiencing will
get better, too, eg you may feel less
tired and less thirsty
Starting insulin injections
Insulin is a protein, so it can’t be
taken in tablet form – otherwise it
would be digested in the stomach
and wouldn’t be able to work. This
is why it needs to be injected via a
small syringe or pen injector. Your
diabetes healthcare team will show
you how to inject insulin, work out
which insulin is best for you and tell
you when you will need to inject.
You’ve probably been given a ‘pen’
injector device – pens are fairly easy
to use and there is a whole range to
suit different types of insulin. The
needles used are very small because
the insulin only needs to be injected
under the skin (subcutaneously) – not
into a muscle or vein. Once injected,
it’s absorbed into small blood vessels
and passes into the bloodstream
Starting insulin injections
doesn’t mean that you’ve
developed Type 1 diabetes.
You still have Type 2 diabetes
but it is treated with insulin
– changing treatment doesn’t
change your condition.
Moving to insulin
Where to inject
There are
four main
places:
Arms*
Stomach
Stomach
Bottom
Bottom
Thighs
Thighs
How to inject
1
2
ake sure your hands and the area you’re
M
injecting are clean.
Eject two units of insulin into the air to make
sure the tip of the needle is filled with insulin
(called an ‘air shot’).
3
4
Choose an area where there is plenty of fatty
tissue, eg tops of thighs or the bottom.
If you have been advised to, lift a fold of skin
(the lifted skin fold should not be squeezed so
tightly that it causes skin blanching or pain) and
insert the needle at a 90° angle. With short
needles you don’t need to pinch up, unless
you are very thin. Check with your diabetes
healthcare team.
* check with your diabetes
healthcare team as arms
aren’t suitable for everyone.
where it gets to work. Most insulin
prescribed today is genetically
engineered ‘human’ insulin, which
doesn’t involve the use of any animal
– or indeed human – products.
If you find your injections a little
painful or uncomfortable, especially
the first few, it may be because you
are tense and anxious. But, as your
confidence grows, they’ll get easier
and become second nature.
Keep on moving
It’s vital that you rotate or change
injection sites. If you keep injecting
into the same site small lumps can
build up under the skin. These won’t
diabetes care
5
ut the needle in quickly. If you continue to find
P
injections painful, try numbing an area of skin by
rubbing a piece of ice on the site for 15–20
seconds before injecting.
6
Inject the insulin, ensuring the plunger (syringe)
or thumb button (pen) is fully pressed down
and count to 10 before removing the needle.
7
8
elease the skin fold and dispose of the
R
used needle safely.
Remember to use a new needle every time.
Reusing a needle will make it blunt and can
make injecting painful.
look or feel very nice, and also
mean that the insulin doesn’t work
properly because it’s harder to
absorb through the lumps. Also,
don’t inject in the same spot within
each site – change the spot that you
use each time. By rotating injection
sites and spots you can help avoid
getting lumps (any that may have
occurred will slowly disappear).
This also applies if you are
prescribed the non-insulin injection.
2013 Type 2 diabetes
13
Diabetes care
TESTING
time
to test
Some people with Type 2
diabetes test their blood glucose
levels, so what does it involve?
It is recommended to prick the side,
rather than the middle of your finger
Y
ou may need to do some form
of testing – either blood or urine
– to understand more about how
your diabetes is being managed.
Whether or not you need to
test should be assessed by your
diabetes healthcare team; they
should talk with you to decide if
it’s right for you.
If you go ahead with testing,
your healthcare team should
assess how you monitor your
blood glucose levels every year
(or more often if it’s needed) as
well as checking that you know
what to do with your results.
Two ways to test
The different ways you can test
your blood glucose at home are:
• Urine testing This involves
holding a special strip under a
stream of urine for a few seconds
and comparing the colour change
14
Type 2 diabetes 2013
on the strip after a set amount
of time (check the manufacturer’s
instructions) with the chart
on the strip container.
This shows whether there is
any glucose in the urine –
a result of ‘none’ is the ideal.
Urine testing gives a less
accurate picture of your blood
glucose level than blood testing,
but your doctor may still feel that
it’s suitable for you. It is less
accurate because there is usually
no glucose in your urine unless
your blood glucose levels have
been persistently over 10mmol/l.
Also, it doesn’t give you an
indication of what your blood
glucose level is at the time you
test, because the urine may
have been produced several
hours before.
Urine tests also can’t tell you
if your blood glucose is too low
– which is important for people
on insulin or certain diabetes
medication. Since the amount of
glucose in the urine is dependent
on a person’s kidney function
and this varies from person to
person, urine tests aren’t always
reliable and can cause confusion.
• Blood testing To test your blood
glucose, you prick the side (as
opposed to the pad) of your finger
with a special device and put a
drop of blood on a testing strip,
which is then read by a blood
glucose meter. The strips for
meters can only be read by the
meter itself. Blood testing gives you
an accurate ‘real time’ picture of
your blood glucose levels. It can
help you to maintain day-to-day
control, find out if you are hypo
(hypoglycaemia – low blood
glucose levels), and also helps to
provide information that can be
used to prevent long-term
TESTING
complications. Your diabetes
healthcare team will teach you
how to do the test properly so that
you can be sure your results are as
accurate as possible and you know
how to respond to these results.
When to test
Your diabetes healthcare team will
help you to understand testing and
together you will agree how many
and what types of tests are best for
you. Sometimes you may be
advised to do a few tests at different
times to get an overall picture of
your diabetes control and show
where changes in your treatment
may be needed. You may also need
to test more if you’re unwell, driving
or doing physical activity. See p78,
86, and 62.
Keeping control
Good control means keeping your
blood glucose levels as near normal
as possible. Research has shown
that good control of blood glucose
levels as well as blood fats (including
cholesterol) and blood pressure
greatly reduces the chances of
developing the long-term
complications of diabetes. Testing
and responding to the results
appropriately can help you reduce
the risk of these complications.
If you test your blood, you should
agree your individual target blood
glucose range with your healthcare
team. This usually means between
4–7mmol/l before meals and under
8.5mmol/l two hours after meals.
Don’t panic if you have the odd
result above the upper limit – this
happens to everyone.
If you’re testing your urine, you’re
aiming for a negative result – but,
again, don’t worry if you occasionally
get a positive result. Good control
also means understanding how your
medication, food and activity affects
your blood glucose. This will give you
the confidence to adjust your
Q& A
My doctor always does a blood test, even though I take
my results book with me to check-ups. Doesn’t he trust
my records?
The test that your doctor does measures your overall control for the
last few weeks – it is not the same test as the ones you do at home.
There are different types of this test. The HbA1c test is the most
common and gives your average blood glucose level for the previous
8–12 weeks. This, along with the tests you do at home, help your
doctor to see how well your treatment is working and to make any
changes necessary. See p22 for more on the HbA1c test.
diabetes care
How to test
blood glucose
1
Wash your hands
rather than using
wet wipes (these
contain glycerine that
could alter the result).
2
3
Make sure your
hands are warm –
if they are really cold
it’s hard to draw
blood, and fingerpricking will hurt more.
rick the side of a
P
finger (not the index
finger or thumb)
– don’t prick the
middle, or too close
to a nail, because
this can really hurt.
4
Use a different
finger each time
and a different part
– this will hurt less.
5
Keep a diary of your
results. This will help
your helathcare team
suggest adjustments
to your treatment,
if needed. Try the
Diabetes UK
smartphone app
to keep track.
www.diabetes.org.uk/
tracker-app
2013 Type 2 diabetes
15
Diabetes care
TESTING
“Quote”
Your target range
Target ranges are agreed between you and your
diabetes healthcare team. For guidance, the
general blood glucose target ranges for people
with Type 2 diabetes are:
– 4–7mmol/l before meals
– less than 8.5mmol/l two hours after meals.
treatment, activity, and what and
when you eat, and avoid high or
low blood glucose levels. Then
you can fit diabetes into your
life, rather than planning your life
around it.
Also, good control means taking
the complications of diabetes
seriously, doing your best to keep
yourself healthy and minimising your
risks – you need to make sure
you are receiving all the essential
health checks (see 15 healthcare
essentials on p29).
Choosing a meter
Your diabetes healthcare team
will usually provide you with a
meter if a decision has been
made that blood glucose testing is
definitely for you. To monitor your
blood glucose levels, not all people
will be given a meter. Testing
strips for the meter will be
prescribed for you, depending
16
Type 2 diabetes 2013
on the amount you need. If you are
choosing a blood glucose meter, it
can be complex as new products
come out all the time. Some
manufacturers also produce
computer software to enable
you to look at trends in your levels.
However, if you buy your own
meter, you may not always get
a prescription for testing strips –
you’ll need to speak to your
healthcare team about this.
The Medical Devices Agency
evaluates all blood glucose meters
that are available in the UK and
ensures that they meet international
standards. If you’re at all unsure
about the most suitable equipment
for your needs, contact your
healthcare team. They should
help you to understand blood
glucose monitoring, support you
in using a meter that meets your
needs and devise a care plan
that suits you (see p24).
ACTION
POINTS
• If you are testing
your blood glucose,
ask your diabetes
healthcare team
what targets you
should be aiming
for and what you
should do about
high/low results.
•
Make sure you
know how to
quality-check your
blood glucose meter
and how often you
should do this.
you’re not
alone with
TESTING
diabetes
bECome a member
Join us today
Diabetes UK is the leading charity that cares for, connects with and
campaigns on behalf of all people affected by and at risk of diabetes.
Over 300,000 supporters are the bedrock of the work we do at Diabetes UK to:
• Help people manage their diabetes effectively by providing information, advice and support.
• Campaign with people with diabetes and with healthcare professionals to improve the quality
of care across the UK’s health services.
• Fund pioneering research into care, cure and prevention for all types of diabetes.
Every supporter makes a difference to the lives of those affected by diabetes.
Members also receive balance every two months, with the latest
information about living with diabetes.
Join today. Call 0800 138 5605 and quote Tesco2 or visit www.diabetes.org.uk/Tesco2
Diabetes care
hypos & hYpers
managing
highs &
lows
People who take certain
medications or insulin may be
at risk of hypos and once
diagnosed you are still at risk
of hypers. Understanding them
will help you to manage them
T
he key to controlling diabetes is
to balance your food, activity and
medication. But it’s not always easy.
When the balance isn’t right, you may
develop hypoglycaemia (hypo – when blood
glucose drops too low) or hyperglycaemia
(hyper – when blood glucose rises too high).
Hypos
Hypoglycaemia (or hypo) means low blood
glucose levels, ie when the blood glucose level
drops below 4mmol/l. In people without diabetes,
low blood glucose levels trigger the body to stop
producing insulin and to release stored glucose
to keep the body going. But, in people with
diabetes, while this mechanism still works,
it’s not so effective.
Some people with Type 2 diabetes may need
tablets or insulin injections to increase the amount
of insulin circulating in the bloodstream. Insulin
produced in this way can’t be ‘switched off’ so it
will continue to work, even though blood glucose
is too low.
If your Type 2 diabetes is controlled by diet and
physical activity alone or by diet and metformin or
acarbose tablets, there is no risk of hypos. But
if you are treating your diabetes with insulin,
sulphonylureas or prandial glucose regulators,
you are at risk of hypos (see p8).
18
Type 2 diabetes 2013
Explaining what hypos are all about to
your friends and loved ones is a good idea
Spotting the symptoms
Hypos can come on quickly and you will tend to
develop symptoms that will indicate that your blood
glucose levels are dropping too low. Everyone has
different symptoms, but common ones are:
• feeling hungry
• trembling or shakiness
• sweating
• anxiety or irritability
• going pale
• fast pulse or palpitations
• tingling of the lips
• blurred vision.
Why do hypos happen?
There’s no hard and fast rule why they happen,
and sometimes there’s just no obvious cause.
But some things that can mean it’s more likely include:
• too much insulin
• a delayed or missed meal or snack
hypos & hYpers
• not enough carbohydrate
• unplanned physical activity (see p62)
• drinking large quantities of alcohol or drinking
alcohol without food (see p50).
treating a hypo
There are a series of steps to take when
treating a hypo:
Immediate treatment
If you have tested your blood glucose and it is low, or
you notice your hypo warnings, take action quickly
or it’s likely to become more severe, and you may
become confused, drowsy or possibly even
unconscious or have a fit. Immediately treat with
15–20g of a fast-acting carbohydrate such as:
• a sugary/non-diet drink
• glucose tablets
• sweets, eg Jelly Babies
• fruit juice
• glucose gel – this can be useful if you’re feeling
drowsy and someone can help you, but should
not be used if you are unconscious (glucose
gel is available on prescription if you are treated
with insulin).
Hypo treatments vary, and the
quantities vary from person to
person. Choose the treatment that
works best for you. But avoid food
and drinks containing fat
(eg chocolate, biscuits, milk).
This is because fat delays the
absorption of sugar, so won’t treat
the hypo quickly enough.
Retest
Check your blood glucose after
15–20 minutes and, if it’s still low,
repeat with the same treatment.
Follow-on treatment
To prevent your blood glucose
levels dropping again, you may
need to follow with 15–20g of
a longer-acting carbohydrate,
diabetes care
such as:
• half a sandwich
• fruit
• a small bowl of cereal
• biscuits and milk
• the next meal, if due.
Explaining hypos to others
Some people find explaining hypos to family, friends
and work colleagues tricky, but it’s better to let them
know in advance what might happen so that if and
when you have a hypo, they can help you deal with
it. Explain why they’ll sometimes see you eating or
drinking sugary things, and tell them what to do if
you can’t manage on your own. Some people find
that they get irritable or stubborn when they go
hypo, so you’ll need to let people know what to
do to get you to eat or drink something.
Severe hypos
A severe hypo is when you need help from
another person to treat it. If a hypo is untreated
there is a risk that you may become unconscious.
While this is not common, it’s important that
you know what to do so you can be prepared:
Hypos & everyday life
There are a few things that you need to be aware of:
Driving
Hypos are most dangerous when you need all your concentration
and co-ordination, such as driving a car. Even a mild hypo,
because of its effects on the brain, can seriously impair your
ability to drive (see p86 for details).
Exercise
Exercise will generally lower blood glucose levels. If your diabetes
is treated with certain tablets or insulin, then you may be at risk
of a hypo if you do intense exercise for a period of over an hour.
So it’s sensible to check your glucose levels before and during
the exercise and to keep some fast-acting glucose such as a
non-diet drink close by. See p62 for more on physical activity.
2013 Type 2 diabetes
19
Diabetes care
hypos & hYpers
tops
tip
• If possible, you should be
placed in the recovery position
(on your side with your head
tilted back)
• If you have been given a
glucagon injection kit (available
as GlucaGen HypoKit), someone
else can help you by injecting it,
but only if the person you are
with has been trained to use it.
If you don’t have a glucagon
kit available or you have not
recovered within 10 minutes
of receiving the glucagon
injection, the person you are
with should put you in the
recovery position and call an
ambulance immediately.
• If you are unable to swallow
or are unconscious, you should
not be given anything by mouth
and ambulance staff should be
called straight away. Make
sure your family and friends
are aware.
• Always tell your diabetes
healthcare team if you have
had a severe hypo as your
treatment may need to
be altered.
Hypos
1
2
Keep hypo treatments
with you at all times.
3
Make sure you carry
some form of ID, an
identity card, bracelet
or necklace, so that if
you ever become unwell
or if you are unable to
communicate in an
emergency, people are
aware that you have
diabetes and can help.
If you’re having nighttime hypos, test your
glucose levels before
you go to bed and
during the night – ask
your healthcare team
about the time to test.
ACTION
POINTS
• Try to understand
the main causes of
hypos and hypers
and take steps to
keep yourself safe.
• Familiarise yourself
with your warning
signs and symptoms
that a hypo or hyper
is taking place and
try to have your
treatment available
at all times.
20
Type 2 diabetes 2013
Hypers
At the other end of the scale are
hypers (hyperglycaemia), which
happen when blood glucose
levels go too high. Some of the
reasons are:
• a missed dose of medication
• too little medication
• eating too much
carbohydrate food
• over-treating a hypo
• stress
• being unwell with an infection.
Symptoms include:
• increased thirst
• frequent urination
• headaches
• extreme tiredness.
Treatment
If your blood glucose level is high
for just a short time, emergency
treatment won’t be necessary. But if
it stays high you need to take action:
• M
ake sure you drink plenty of
sugar-free fluids.
• If you are on insulin, you may need
to take extra insulin.
• If you are feeling unwell, especially
if you are vomiting, you must
contact your diabetes healthcare
team for advice.
hypos & hYpers
diabetes care
better to let people
“It’s
know in advance
what might happen
”
Q& A
Should I keep my blood glucose levels
high to avoid hypos?
No. It can be harmful for you if you try to run your
blood glucose levels consistently very high in order
to avoid hypos. You may start to feel thirsty, go to
the loo a lot and feel tired – basically you will feel
like you did before you were diagnosed. Long-term
high blood glucose levels can lead to complications
(see p90 onwards).
What are the main reasons for hypos?
The most frequent cause is missing or delaying a
meal, but occasionally it might be a mistake in your
medication dose or unplanned exercise. Stress, or
very hot or cold weather, also causes some people
to have hypos. If there’s a simple explanation for the
odd hypo, there’s no need to adjust your treatment.
It’s only if you have frequent hypos at similar times
or if you have a severe hypo that you may have to
look at what you eat or your medication doses.
Speak to your diabetes healthcare team for advice
or if you have any concerns. You may also find that
it helps to do more blood glucose tests. That way,
you’ll be able to spot when your levels are likely to
drop and take action, without running your levels
too high all the time.
How do hypos affect my blood glucose levels?
After you’ve had a hypo, your blood glucose level
may actually rise. If you are on insulin don’t be
tempted to increase your dose. The rise may happen
because you felt incredibly hungry during the hypo
and ate to correct this. Your levels may also rise
because hypos cause the body to mobilise its own
glucose stores.
Will hypos affect my quality of life?
Unfortunately, occasional hypos may happen.
But they should not be frequent or severe.
If they are, contact your diabetes healthcare team.
Try to build a picture of any hypos you have to see
if there is a pattern in their occurrence. If there is,
you may wish to alter your diabetes treatment
with the help of your healthcare team.
Why do some people have severe
hypos without any warnings?
Research suggests that people who keep their
diabetes very tightly controlled may have problems
in recognising hypo warnings. Research also shows
that if you have one severe hypo without warnings,
you’re more likely to have repeated episodes. And
once you’ve had one severe hypo, you are at risk of
further severe hypos, so you should take particular
care. There is also some evidence that people
who’ve had diabetes for a long while may have lost
their hypo warnings. However, they can often regain
them by adjusting their diabetes treatment. If you’re
having problems, talk them through with your
diabetes healthcare team. They’ll be able to give
you individually tailored advice.
2013 Type 2 diabetes
21
Diabetes care
long-term testing
long-term control
You’ll be invited for various tests at least once a year
to check on your overall health now that you have
diabetes. There will be particular targets to aim for
M
onitoring your health when you have
diabetes is crucial to prevent some
of the complications associated with the
condition. This involves knowing your
blood glucose, blood pressure and blood
fat levels, and there are targets you should
be aiming for. As well as day-to-day blood
glucose testing, the HbA1c test (usually
done from a fingertip blood test) measures
your diabetes control over two to three
months. This target and the others are:
• H
bA1c: below 48mmol/mol but
58mmol/l or below for those at risk
of severe hypoglycaemia
• Blood pressure: 130/80mm Hg or less
• Blood fats:
– total cholesterol: below 4mmol/l
– LDL (bad fat): below 2mmol/l
– HDL (good fat): 1mmol/l or above for men, 1.2mmol/l or above for women
– triglycerides: 1.7mmol/l or below.
Remember, target ranges are individual
and your diabetes healthcare team may
suggest a different target to you.
• See p29 for 15 healthcare essentials.
For more on complications, see p90.
22
Type 2 diabetes 2013
Q& A
I have sickle cell anaemia
and my doctor has said
that he can’t do the HbA1c
test on me. Why is this?
HbA1c measures the amount
of glucose that is being
carried by the red blood cells
in the body. But red blood
cells are affected if you are
anaemic, or have a condition
like sickle cell anaemia or
thalassaemia (all of which
involve a lack of, or abnormal
type of, haemoglobin – the
‘oxygen carrying’ part of the
blood). So this means that the
test will give a false result.
DIABETES
?
W
O
N
K
O
T
D
E
NE
?
K
L
A
T
O
T
D
NEE
Our CARELINE is staffed by professional counsellors
who have extensive knowledge of diabetes.
They can provide information about diabetes, take the
time to talk things through and explore emotional,
social, psychological or practical difficulties you may
be experiencing.
The telephone service:
• is available during working hours on all weekdays
• provides access to a translation service for people who do not want to speak English
• welcomes calls via Text Relay for people with a hearing impairment
• offers recorded information on the most popular diabetes-related subjects out of hours.
You can contact us directly any time between 9am and 5pm, Monday to Friday.
EMAIL [email protected]
CALL 0845 123 2399*
WRITE TO Diabetes UK Careline, 10 Parkway, London NW1 7AA
*The cost of calling 0845 numbers can vary according to the provider. Please check with your
own provider for details, particularly about mobile phones as they can cost considerably more
than landline calls. Or call 020 7424 1030 and your call will be connected directly to the Careline.
A charity registered in England and Wales (215199)
and in Scotland (SC039136). © Diabetes UK 2013
2013 Type 2 diabetes
23
Diabetes care
THE care to expect
YOUR CARE EXPLAINED
It takes a team of professionals to
provide the best possible diabetes
care. Find out who’s in your team
and what care and services to expect
Y
our diabetes healthcare team
is made up of all the healthcare
professionals who are involved in
your care, but you won’t see them
all together at the same time.
Your diabetes care may be
provided in different places
depending on your specific needs,
but most likely at your GP surgery.
It is best to discuss with your GP
the roles and responsibilities of
those providing your diabetes
care. It is important to identify
the key members of your diabetes
healthcare team and agree the
name of the key contact, who
you are likely to see most often.
You may see some members
of your team more often than
others and they may change
over time.
To achieve the best possible
diabetes care, it is essential for you
to work in partnership with your
diabetes healthcare team and use
your combined experience and
expertise to agree what care and
support you need. Remember, the
most important person in the team is
you – because the decisions made
will affect you. (See ‘Planning your
diabetes care’, right).
Your healthcare
team will have a
wealth of experience
Planning your
diabetes care
The partnership between
you and your diabetes
healthcare team, where
you are actively involved in
deciding how your diabetes
will be managed, is a
process called ‘care
planning’.
During your appointments,
you should:
• discuss your concerns
and questions with
members of your
diabetes healthcare team
• work together to set
realistic goals
• decide how you are going
to achieve these goals.
Your healthcare
team will have
The goals you agree
during
a wealth of
your discussionsexperience
will form
the basis of your care plan,
which is the written
summary of what you and
your diabetes healthcare
team are both going to do
to help you to manage
your diabetes.
A paper copy of your
care plan should be given
to you by a member of your
diabetes healthcare team.
If not, ask for one.
24
Type 2 diabetes 2013
THE care to expect
most important
“The
person in your diabetes
team is you
”
What care to expect
It is important that you understand your diabetes and
the healthcare you can expect so that you are an
effective member of your own diabetes healthcare
team. There are different stages that your care will
go through:
When you have just been diagnosed
with diabetes, you should:
• Have a full medical examination and discuss with
a member of your diabetes healthcare team any
immediate treatment you need; your concerns and
unanswered questions; your feelings and reaction
to being diagnosed.
• Receive an explanation of what’s on offer for
you to learn more about diabetes and keeping
well. This includes diabetes education and
self-management courses (see p30), as well
as other sources of information and support.
• See a registered dietitian to talk about what you
usually eat, how this relates to your condition,
and what other information and support will help
you manage your food and diabetes.
Once you have received initial information
and treatment, your ongoing care includes:
• A yearly formal care planning review with a doctor or
nurse experienced in diabetes. This should include a
discussion of your test results and examinations, as
well as your experiences of living with diabetes and
any other concerns, needs or anxieties.
• Full review every year to check for complications
(see the 15 healthcare essentials p29).
diabetes care
tops
tip
Appointments
Before
• decide what you need to know
• write down the points you want to raise
• bring your blood glucose meter and
results record with you
• bring any news features/stories or research
that you have any questions about.
During
• listen actively – ask questions, give
feedback and ask for clarification if
you’re unsure of anything
• make notes to help you remember
what has been said
• check you’ve covered your list.
After
• review what’s been said and agreed
• make a note of anything you need to
do before your next appointment.
• Regular access to your healthcare team to assess
your diabetes control. This could be every four to
six months, or as agreed in your care plan. You
should have the time to ask questions and to
discuss your care.
• Access to a member of your healthcare team for
specific support and advice when you need it.
This could be in person or by phone, email or text,
depending on what is used in your area.
2013 Type 2 diabetes
25
Diabetes care
THE care to expect
As part of your ongoing care
your healthcare team is there to
support you to manage your
diabetes. They will:
• P
rovide continuity of care, ideally
from the same doctors and
nurses, or if this isn’t possible,
doctors or nurses who are fully
aware of your medical history
and background and are
experienced in diabetes. They’ll
work with you to continually
review and update your care
plan, including your diabetes
management goals.
• M
ake sure that you understand
and are involved in the decisions
about your treatment or care.
This means having access to
your results with information
about what they mean, so you
can ask questions and make
sure your personal goals are
reflected in copies of any letters
written about your diabetes.
• A
sk you how you are feeling
and give you information on
available emotional and
psychological support.
• If you need it, organise pre- and
post-pregnancy advice together
with your obstetric team.
• E
ncourage you to gain support
from your friends, partner and/or
relatives and from other people
with diabetes.
• Provide you with ongoing
education sessions, appointments
and information on different ways
you can learn about diabetes, eg
websites, books, support groups,
courses and conferences.
• Offer you a review of your
medicines, which may be via
your pharmacist.
26
Type 2 diabetes 2013
• G
ive you information on the
effects of diabetes and
treatments when you are ill
or taking other medication.
• Give you information about how
to dispose of your used sharps
(injection needles and/or blood
glucose monitoring lancets) and
local arrangements for collection
of sharps disposal boxes.
• Help you access specialist
services when you need
them, for example specialist
foot services.
If your diabetes is treated by
insulin or non-insulin injections
your care should also include:
• Contact (face-to-face, telephone,
email or text messages) with your
diabetes healthcare team. This
will be frequent at first, as you
learn how to inject, look after
your insulin or non-insulin
medication, syringes, injection
pen and how to dispose of
needles (sharps).
• Being shown how to test your
blood glucose and be informed
what the results mean and what
to do about them.
• Being given supplies of, or a
prescription for, the medication
and equipment you need.
• A discussion about hypo- and
hyperglycaemia episodes,
when and why they may
happen and how to deal
with them.
• An examination of your injection
sites to check insulin can be
absorbed properly.
• How illness can affect blood
glucose levels and how to
manage episodes of illness.
If your diabetes is treated by
other medication or by healthy
eating and physical activity,
your care should include:
• information about testing your
blood or urine glucose at home
and a discussion of what the
results mean and what to do
about them
• supplies of, or a prescription
for, the medication and
equipment you need (see
below about ‘prescriptions’)
• a discussion about
hypoglycaemia (hypos) episodes
if relevant to your treatment, when
and why they may happen and
how to deal with them.
Prescriptions
In the UK, people with
diabetes who take diabetes
medications are entitled to free
prescriptions, but you’ll need a
prescription exemption
certificate. Talk to your GP,
diabetes nurse or pharmacist
about how to apply for one.
Equipment such as test strips,
lancets, syringes, insulin pens,
pen needles and sharps
boxes are all available on
prescription. Your diabetes
specialist nurse will usually
provide you with a blood
glucose meter and fingerpricking device.
THE care to expect
Hospital stay
If you are admitted to hospital for any
reason (diabetes related or not), here
are a few tips to bear in mind:
• If you are having a planned
operation or examination,
discuss a plan for your diabetes
care in hospital at your preassessment appointment. The
plan should include information
about what will happen before,
during or after your procedure.
• If you wish to manage your
diabetes care during your stay
in hospital, you should have
access to your own medication,
hypo treatment and equipment
(including blood glucose
monitoring equipment) – if you
don’t have everything to manage
your diabetes, the appropriate
hospital staff should be able to
provide you with what you need.
• If you’re admitted unexpectedly
and you would prefer to use your
own diabetes equipment, you
could ask a friend, carer or
relative to bring it in for you.
• If you have any concerns about
your diabetes care, speak to the
hospital staff – they can contact
the diabetes healthcare team
if necessary.
• After your stay in hospital, if any
changes have been made to
your treatment, you and your
usual diabetes healthcare team
should be informed of them and
receive information about
ongoing management.
diabetes care
Q& A
I’m not happy with my
healthcare. What can I do?
If you are unhappy or dissatisfied
with the care you are receiving,
try to deal with minor irritations
at the time and with the person
involved. Look carefully and
honestly at what happened.
Persistent problems should be
taken up with the person in
charge of the surgery or clinic.
If you are still unhappy, you can
take your complaint further.
There are a different series of
steps to follow in each country
within the UK. For more details,
visit www.diabetes.org.uk/
your-concerns
are entitled to
“You
free prescriptions if
you treat your diabetes
with medication
”
ACTION
POINTS
• Discuss the roles and responsibilities of
those providing your diabetes care with
your GP so you know who to contact as
and when.
• Find out who the key members of your
diabetes healthcare team are and agree
the name of the person you’ll see most
often. They will become your main contact.
2013 Type 2 diabetes
27
Diabetes care
THE care to expect
Meet your team
It’s important to identify the
key members of your diabetes
healthcare team and agree the
name of the key contact. This is
the person you are likely to see
the most often. You may see
some members of your team
more often than others and the
individuals involved may change
over time. It is best to discuss
with your consultant or GP the
roles and responsibilities of those
providing your diabetes care.
Your GP has overall responsibility
for the care you receive at your
local surgery. Some may play a
central role in monitoring your
diabetes and prescribing
treatment. But others, who are
not diabetes experts, may refer
you to a clinic (either hospital
or community) or a special
diabetes centre.
Practice nurses are based at
your surgery and may provide
your diabetes care. Some may
28
Type 2 diabetes 2013
have specialist knowledge
of diabetes.
Diabetes specialist nurses
(DSNs) have special expertise
in diabetes. They will usually
provide telephone advice
between your appointments.
Some may advise on how to alter
your medication. Most hospitals
and community clinics have
DSNs and some GP surgeries
have DSNs visiting during
diabetes clinics.
Diabetologists are consultants
who specialise in diabetes. They
are usually based at a hospital
clinic or specialist diabetes
centre, although some areas
have community diabetologists
who provide diabetes care and
support in community clinics.
Registered dietitians work
with you to assess your eating
habits and help you make
lifestyle and food choices in
order to manage your diabetes.
Everyone with diabetes should
see a registered dietitian for
individual dietary advice.
Registered podiatrists manage
foot problems related to diabetes.
They advise on shoes, and check
and treat conditions of the foot
and lower limb. You should be
referred from your hospital clinic
or GP surgery, if necessary.
Ophthalmologists are
doctors with specialist training
in the diagnosis and treatment
of conditions that affect the eye.
You should be referred from your
hospital clinic or GP surgery.
Pharmacists are based in all
pharmacies and chemists. They
give you supplies of medication
when you provide them with a
prescription from your GP. Many
also provide lifestyle advice and
medication reviews.
Psychologists help you to cope
with the impact that your diabetes
has on your life. You should be
referred from your hospital clinic
or GP surgery, if necessary.
THE care to expect
diabetes care
15 healthcare essentials
Having the right care is essential for the wellbeing of all people with diabetes. There is a minimum level
of healthcare that every person with diabetes deserves and should expect. Here are the 15 essential
checks and services you should receive. If you aren’t getting all the care you need, take this checklist
to your diabetes healthcare team and discuss it with them
1
10
2
3
11
4
12
Get your blood glucose levels measured at least
once a year. An HbA1c blood test will measure your
overall blood glucose control and help you and your
diabetes healthcare team set your own target.
Have your blood pressure measured and recorded
at least once a year, and set a personal target that
is right for you.
Have your blood fats (cholesterol) measured every
year. Like blood glucose levels and blood pressure,
you should have your own target that is realistic
and achievable.
Have your eyes screened for signs of retinopathy
every year. Using a specialised digital camera, a
photo of each eye will be taken and examined by a
specialist who will look for any changes to your
retina (the seeing part at the back of your eye).
Have your feet checked – the skin, circulation and
nerve supply of your feet should be examined annually.
You should be told if you have any risk of foot
problems, how serious they are and if you will be
referred to a specialist podiatrist or foot clinic.
Have your kidney function monitored annually. You
should have two tests for your kidneys: urine test
for protein (a sign of possible kidney problems) and
a blood test to measure kidney function.
Have your weight checked and have your waist
measured to see if you need to lose weight.
Get support if you are a smoker including advice
and support on how to quit. Having diabetes already
puts people at increased risk of heart disease and
stroke, and smoking further increases this risk.
Receive care planning to meet your individual needs
– you live with diabetes every day so you should
have a say in every aspect of your care. Your
yearly care plan should be agreed as a result
of a discussion between you and your diabetes
healthcare team, where you talk about your
individual needs and set targets. If you live in
Northern Ireland care planning is different.
5
6
7
8
9
Attend an education course to help you
understand and manage your diabetes.
You should be offered and have the opportunity
to attend courses in your local area.
Receive paediatric care if you are a child or young
person. You should receive care from specialist
diabetes paediatric healthcare professionals.
When the time comes to leave paediatric care,
you should know exactly what to expect
so you have a smooth change over to adult
health services.
Receive high-quality care if admitted to
hospital. If you have to stay in hospital, you
should still continue to receive high-quality
diabetes care from specialist diabetes
healthcare professionals, regardless of
whether you have been admitted due to
your diabetes or not.
Get information and specialist care if you are
planning to have a baby as your diabetes control
has to be a lot tighter and monitored very closely.
You should expect care and support from
specialist healthcare professionals at every stage
from preconception to post-natal care.
See specialist diabetes healthcare professionals
to help you manage your diabetes. Diabetes
affects different parts of the body and you should
have the opportunity to see specialist
professionals such as an ophthalmologist,
podiatrist or dietitian.
Get emotional and psychological support.
Being diagnosed with diabetes and living with a
long-term condition can be difficult. You should
be able to talk about your issues and concerns
with specialist healthcare professionals.
13
14
15
To find out how the 15 healthcare essentials
are provided in your local area, visit
www.diabetes.org.uk/Diabetes-Watch-online-tool
2013 Type 2 diabetes
29
Diabetes care
EDUCATION
Following
the right
course
Courses may be taught in person
(face-to-face or in groups) or online
D
iabetes UK advocates that
all people with diabetes,
should receive the education
and support they need to enable
them to manage their own
condition. It is also part of
the 15 healthcare essentials
(see p29).
Diabetes is a lifelong condition
and having the understanding,
knowledge and skills to effectively
manage it can make a big
difference to your life. This is
why education is very important
and should be offered to you.
There are lots of different
education courses available for
people with diabetes and they
vary in length and the types of
things covered. They should
include information about how
to manage your diabetes
through diet, physical activity
and medication. The courses
can take place in groups,
one-to-one sessions or
even online.
30
Type 2 diabetes 2013
There are a broad range of educational
courses available for people with
diabetes, to help you learn about
and manage your condition, so
it’s important to pick the one that
is right for you
Q& A
When choosing an education
course you should ask the
following questions.
• Is the programme relevant
to my type of diabetes?
• Can I commit enough time
to complete the programme
in full?
• Is the programme run
by qualified healthcare
professionals?
• Do I meet the requirements
set out by the programme?
• Am I happy to take a more
involved and proactive role
in my diabetes care?
It is important that the
course suits you, talk to
your nurse and/or dietitian
about what is available.
What is structured education?
It is a course that meets the
criteria set by the National
Institute for Health and Clinical
Excellence (NICE).
What are the criteria that
the course should have?
• a patient-centred philosophy
• a structured, written curriculum
• trained educators
• be quality assured
• be audited.
ACTION
POINTS
i For more information
and examples of the
types of courses
available, visit:
www.diabetes.org.uk/
structured-education
• Speak with your diabetes
healthcare team about what
local courses are available.
health information online
diabetes care
caught in
the web?
Not all the information found on the internet
is 100 per cent accurate. Here are some tips
that will help you sift out the quality advice
Ask your healthcare team to
recommend some good websites
A
s we rely more and more on
the internet for information, it’s
tempting to accept that everything
we discover is truthful. But when
it comes to health information it
always pays to be cautious.
Following some simple guidelines
will help you to steer clear of any
unscrupulous traders and ditch
out-of-date information and advice.
• If there’s any health-related
articles online that interest you,
talk them through with your
healthcare team. Remember
to take a copy with you.
• Ask your healthcare team to
recommend good, relevant sites.
• Be cautious about buying medical
products via the internet. In most
countries, selling and buying
medical products online is an
illegal activity. You’re far better
getting your medical products at
pharmacies or through your
healthcare team.
• Beware of sites offering a cure
for diabetes. Research advances
every day, but there’s no cure.
• C
heck that links on the site are
still ‘live’. ‘Dead’ links tend to
indicate that other information
on the site will also be out of date.
• B
e critical. Remember that
if it sounds unbelievable –
it probably is.
• D
on’t be fooled by the use
of high-tech websites. Just
because a site looks good,
doesn’t necessarily mean that
the content will be high quality.
• If you’re unable to check online
information with your GP or
member of your diabetes
healthcare team, Diabetes UK
Careline may be able to help you
– call 0845 123 2399 or email
[email protected].
• D
on’t rely on search engines to
find information and use a reliable
source instead. See right for
some recommended sites.
There are also several good
online diabetes forums. Generally
the advice, shared knowledge
and experience you’ll receive is
very useful, but don’t change
treatments or make any
alterations to your lifestyle
until you have discussed them
with your healthcare team.
Sites you can trust
Diabetes UK
www.diabetes.org.uk
Diabetes Support Forum
www.diabetessupport.co.uk
NHS Direct
www.nhsdirect.nhs.uk NHS Choices
www.nhs.uk
National Institute for Health
and Clinical Excellence
www.nice.org.uk
Health Protection Agency
www.hpa.org.uk/HPA
2013 Type 2 diabetes
31
FOOD
a healthy balance
Getting the
balance right
We know we’re meant to eat a healthy, balanced diet,
whether we have diabetes or not. Here’s how to get it right
E
veryone needs to make
sure they get enough fruit
and vegetables, milk and dairy,
carbohydrate and protein every
day. And no food is off limits
when you have diabetes –
it’s fine to have a treat every
now and again, just don’t
overindulge. The foods you
choose are an important part of
your diabetes treatment, just like
taking your medication, testing
blood glucose and being active.
Food can be divided into
five groups:
32
Type 2 diabetes 2013
1
2
5
3
4
1Starchy foods
Bread, rice, potatoes and pasta
contain the all-important nutrient
carbohydrate, which is broken
down into glucose and used by
the body’s cells as fuel. Try to choose
those that are more slowly absorbed
(have a lower Glycaemic Index, see
p40), as these won’t affect your
blood glucose levels as much.
Starchy foods are naturally low in fat,
and the high-fibre varieties are good
for keeping your bowels regular and
preventing digestive disorders.
How much per day?
5–14 portions. One-third of
your diet should be made up
of these foods, so try to include
them in all meals.
What’s a portion? One portion
is equal to: 2–4 tbsp cereal;
1 slice of bread; 2–3 tbsp rice,
pasta, couscous, noodles or
mashed potato; 2 new potatoes
or half a baked potato; half
small chapatti; 2–3 crispbreads
or crackers.
a healthy balance
2 Fruit & vegetables
All of these foods are low in fat and calories,
and packed with vitamins, minerals and fibre,
which are vital for good health. They can help
protect against stroke, heart disease, high blood
pressure and certain cancers.
How much per day? Aim for at least 5 portions.
Fresh, frozen, dried and tinned fruit and veg all count.
What’s a portion? Roughly what you can fit into the
palm of your hand. It’s best to mix and match fruit and
veg to get as wide a range of vitamins and minerals as
possible. See p34, point 4 for some examples.
3 Dairy products
Milk, cheese and yogurt contain calcium, which helps
to keep your bones and teeth strong. They are also a
good source of protein, but some can be high in fat,
so choose lower-fat alternatives where you can.
How much per day? Aim for 3 portions.
What’s a portion? ¹/3 pint of milk; a small pot of
yogurt; 2 tbsp cottage cheese; or a matchbox-sized
portion of cheese (40–45g/1½oz).
4 Foods high in fat and sugaR
Technically, your body doesn’t need any foods in
this group, but eating them in moderation will still
mean you are following a healthy, balanced diet.
Sugary foods will raise your blood glucose, as will
sugary drinks, so bear this in mind and choose diet
or low-calorie soft drinks instead. It’s also worth
remembering that fat contains a lot of calories, so
try to reduce the amount of oil you use in your cooking
and choose lower-fat alternatives where possible.
FOOD
How much per day? 0–4 portions (the fewer
the better).
What’s a portion? One portion is equal to:
2 tsp spread, butter, oil, salad dressing, sugar,
jam or honey; 1 tbsp Bombay mix; rasher of bacon;
¹/3 of a vegetable samosa; 1 mini chocolate bar;
1 scoop of ice cream or 1 tbsp cream.
5 Meat, fish, eggs & pulses
These foods are high in protein, which is needed for
building and replacing muscle cells in the body. They
also contain minerals, such as iron, which are needed
for producing red blood cells. Omega-3 fish oils, found
in oily fish such as mackerel, salmon and sardines, can
help to protect the heart. Good sources of protein for
vegetarians are beans, pulses, lentils, soya and tofu.
How much per day?
Aim to have 2–3 portions.
What’s a portion?
One portion is equal to:
60–85g (2–3oz) meat,
poultry or vegetarian
alternative; 120–140g
(4–5oz) fish; 2 eggs;
2 tbsp nuts; 3 tbsp
beans, lentils or dahl.
The number of
portions people need
varies, and these are
given as a guide. Your
dietitian will be able to
tell you how much
you should eat.
Seasoning
Eating too much salt (6g/0.2oz or more per day)
can raise your blood pressure, which can lead to
stroke and heart disease, so limit the amount of
processed foods you eat and try flavouring foods
with herbs and spices instead.
2013 Type 2 diabetes
33
FOOD
Top Tips
TOP TIPS FOR EATING WELL
There are many ways you can enjoy eating well. Small, simple
changes all go a long way to improving your diet and help to
protect your long-term health. Here are our top 10 tips…
1Eat regular meals
2INCLUDE CARBS
It’s important not to skip your meals.
Try to space them evenly throughout the
day as this will help control your appetite
and blood glucose levels – especially if you
are on twice-daily insulin.
3 CUT THE FAT
Eat less fat – particularly saturated fat –
as a low-fat diet is healthier for you. So try:
• unsaturated fats and oils, especially
mono-unsaturated fats like olive oil
and rapeseed oil, as these types
of fat are better for your heart
• using skimmed or semi-skimmed
milk and other low-fat
dairy products
• grilling, steaming or baking
foods instead of frying.
Include starchy
carbohydrate foods in
your diet. Carbohydrate
(carbs) affects blood
glucose levels, so be
conscious of how much you
eat (see p36). The best carbs
are those our bodies absorb
slowly. Try:
• pasta, basmati or easy-cook rice
• granary, pumpernickel or
rye breads
• new potatoes, sweet potatoes
and yams
• oat-based cereals, such as
porridge or natural muesli.
’T BE MEAN
5 DON
WITH THE BEANS
4
34
TRY THE ‘FIVE A DAY’ RULE
Aim for at least five portions of fruit
or vegetables a day to give our bodies all the
vitamins and minerals and fibre we need.
A portion is:
• 1 piece of fruit, like a banana
or apple
• 1 handful of grapes
• 1 tbsp dried fruit
• 1 small glass of fruit juice or
fruit smoothie
• 3 heaped tbsp vegetables.
Type 2 diabetes 2013
rilliant beans, lovely lentils
B
and perfect pulses. They’re
all low in fat, high in fibre,
cheap to buy and packed with nutrition.
They don’t have a big impact on blood
glucose and may help to control blood fats
(eg cholesterol). And there are so many
to choose from: kidney beans, chickpeas,
green lentils, and even baked beans.
Try them:
• hot in soups and casseroles,
or cold in salads
• in baked falafel, bean burgers and
low-fat hummus and dahls.
TOP TIPS
FOOD
AY ‘YES’ TO
7SLESS
SUGAR
6 DISH UP THE FISH
All types of fish are healthy,
but top choices are oily fish like
mackerel, sardines, salmon
and trout. These contain
polyunsaturated fat, called omega-3,
which helps protect against heart
disease. Aim to eat 2 portions
of oily fish a week, ideally from a
sustainable source.
This doesn’t mean you need to eat a sugar-free diet. You can include some sugar in foods and baking as part of a healthy diet, just aim to have less of it. You can use sweeteners as an alternative to sugar, too. Some easy ways to cut back on your sugar intake are:
• choosing sugar-free, no-added sugar
or diet fizzy drinks and squashes
• buying canned fruit in juice rather
than syrup
• reducing or cutting out sugar in
tea and coffee.
LOW
8 SDOWN
ON
THE SALT
Reduce salt in your
diet to 6g or less a
day. Too much salt can raise
your blood pressure, which
increases your risk of heart
disease and stroke.
• 70 per cent of our salt intake
comes from processed foods,
so cut back on these types of
food where you can.
• Try flavouring foods with herbs
and spices instead of reaching
for the salt cellar.
Remember, sugary drinks are an excellent treatment for hypos.
9 THINK BEFORE YOU DRINK
The recommended daily alcohol limit for
women is 2–3 units and 3–4 units for men.
• 1 unit is a single measure (25ml) of spirits
• half a pint (284ml) of lager, beer or cider
has 1 to 1½ units, and a 175ml glass
of wine up to 2 units.
• Alcohol is high in calories. To lose
weight, think about cutting back.
• Never drink on an empty stomach as
alcohol can make hypos (hypoglycaemia
– low blood glucose level) more likely to
happen if you are at risk of hypos. See
p52 for more on alcohol.
10 DITCH ‘DIABETIC’ FOODS
These products offer no benefit to people with diabetes
and may still affect your blood glucose levels. They contain
as much fat and calories as ordinary versions, they are
expensive and can have a laxative effect.
2013 Type 2 diabetes
35
FOOD
CarbohydraTes
THE CARB CONNECTION
Carbohydrates are
often in the spotlight
and there are
conflicting stories
about why we need
them, what they really
do, which ones are
best and how much
we should eat or not
(in the case of lowand no-carb diets).
So let’s go back
to basics…
WHAT ARE CARBOHYDRATES?
There are two main types of carbohydrate –
starchy carbohydrates and sugars.
Starchy carbohydrates: These include bread, pasta,
chapattis, potatoes, yam, noodles, rice and cereals.
Sugars: These can be divided into naturally occurring
sugar and added sugar. Natural sugars are found in
fruit (fructose) and some dairy products (lactose).
Added sugars are found in table sugar, glucose syrup,
invert syrup and honey. Sugars can often be identified
on food labels as those ingredients ending in ‘ose’,
eg sucrose, glucose, lactose, fructose.
Why do we need carbohydrate?
Carbohydrate is a nutrient and is an important
source of energy. All carbohydrates that you eat
and drink are broken down into glucose, which is
36
Type 2 diabetes 2013
the body’s essential fuel that keeps us functioning
– especially the brain. High-fibre varieties are
important for keeping your bowels regular and
preventing digestive disorders.
How much do we need?
It depends on your age, weight and
activity levels. In ‘Getting the balance right’ (p32),
we looked at carbohydrate portions – what they
are and how much is needed. Remember that all
carbohydrates break down into glucose, and the
total amount you eat and drink will have an effect
on your blood glucose levels, so being aware of
how much carbohydrate you are eating could help
you to achieve your optimal glucose control. If
you’re taking fixed amounts of insulin, you may find
it beneficial to have consistent amounts of
carbohydrates on a day-to-day basis. Your dietitian
will help you find the balance that suits you.
FOOD
Run towards
a
future
without diabetes
Run for team Diabetes UK
It’s a great way to help you get fit and
healthy, and help manage your diabetes.
To sign up for a Bupa Great Run:
CLICK www.diabetes.org.uk/bupa
CALL 0845 123 2399
EMAIL [email protected]
2013 Type 2 diabetes
37
FOOD
CarbohydraTes
GI CONCEPT
EXPLAINED
You may have heard about
the Glycaemic Index (GI), which
is a ranking of carbohydratecontaining foods based on their
overall effect on blood glucose
levels. Here’s how you can take
this into account when it comes
to your diabetes
F
oods are given a GI number
according to their effect on
blood glucose levels. Glucose
is used as a standard reference
(GI 100) and other foods are
measured against this.
Slowly absorbed foods have a
low GI rating, while foods that are
more quickly absorbed have a
higher rating. This is important
because, when you have diabetes,
choosing slowly absorbed
carbohydrates instead of quickly
absorbed carbohydrates, can help
even out blood glucose levels.
Research into low-GI diets has
shown some benefits in HbA1c
levels in people with Type 2
diabetes. They have also been
linked with improved levels of
‘good’ cholesterol and a lower rate
of heart disease.
Does anything affect GI?
Factors may include:
• Cooking methods: frying, boiling
and baking.
38
Type 2 diabetes 2013
• Processing and the ripeness
of fruit and certain vegetables.
• Wholegrains and high-fibre foods
act as a physical barrier that
slows down the absorption of
carbohydrate. This is not the
same as ‘wholemeal’, where,
even though the whole of the
grain is included, it has been
ground up instead of left whole,
eg some mixed grain breads
that include wholegrains have
a lower GI than wholemeal or
white bread.
• Fat lowers the GI of a food. For
example, chocolate has a
medium GI because of its fat
content and crisps will actually
have a lower GI than potatoes
cooked without fat.
• Protein lowers the GI of food. Milk
and other dairy products have a
low GI because they are high in
protein and contain fat.
If you only ate low-GI foods, your
diet could be unbalanced and high
in fat and calories, which could lead
to weight gain (making it harder to
control your blood glucose levels)
and increase your risk of heart
disease. So, it’s important not to
focus exclusively on GI and to think
about the balance of your meals,
which should be low in fat, salt
and sugar, and contain plenty
of fruit and vegetables.
How do I find out the GI
values of all food?
There are books that give a long
list of GI values for many different
foods, though this does have its
limitations. The GI value relates to
the food eaten on its own and we
usually eat foods in combination
as meals.
How can I get the benefit of GI?
You can maximise the benefit of
GI by switching to a low-GI option
food with each meal or snack.
A few suggestions are given in
the table, right.
CarbohydraTes
How strict should I be with
applying the GI concept?
Eating to control your diabetes
isn’t just about GI ratings and
shouldn’t be used in isolation.
Choosing foods solely on the
basis of their GI, without
regard to their content of
energy, saturated fat or
salt, is unlikely to be a
healthy diet.
Although some research has
shown that low-GI diets help in
controlling blood glucose levels,
the amount of carbohydrate
you eat has the biggest influence
on your blood glucose levels
after meals.
FOOD
of the
“Allcarbohydrate
that you eat
and drink are
broken down
into glucose
”
Making the most of low-GI foods
u
BREAKFAST
Lunch
Try an oat-based breakfast cereal, eg porridge.
u Add sliced fruit to wholegrain breakfast cereals.
u A
dd baked beans to your jacket potato and serve with
a large green salad.
u Try a bean-based or vegetable soup.
u Eat a variety of grainy or pumpernickel bread, instead
of white or wholemeal bread.
u Consider boiled potato or sweet potato instead of mashed
potato with your meal.
Evening meal
u Choose basmati or easy-cook rice instead of long-grain rice.
u Include plenty of vegetables with your meals.
u Include more beans and lentils in your meal; try adding
them to casseroles and curries.
u Get into the habit of eating fruit.
Snacks
u Low-fat yogurt.
u Popcorn.
u Go easy on lower-GI foods like chocolate and nuts,
which are high in fat and calories, especially if you are
trying to lose weight, so save them for occasional treats.
2013 Type 2 diabetes
39
FOOD
food labelling
looking
at labels
The first step to eating more
healthily is understanding
what is in your food
M
ost supermarkets and large food and drink
manufacturers display ‘traffic light’ and/or
Guideline Daily Amount (GDA) food labels on
the front of their products to help you make
informed (and healthier) choices. Here are
the different systems explained:
Traffic light labelling
These tell you if the product has low (green),
medium (amber) or high (red) amounts of fat,
saturated fat, sugars, salt and calories per portion
(see Table 1, below, for a guide). So the healthier the
food, the more green lights it will have. Most foods
will have a mixture of different-coloured lights, so try
to choose products with more green and amber
lights than red.
light and/or GDA
“Traffic
food labels help you to
make informed choices
Table 1: What is ‘high’, ‘medium’ and ‘low’ per 100g?
40
per 100g
Low
Medium
High
Sugars
5g or less
5.1g–15g
More than 15g
Fat
3g or less
3.1g–20g
More than 20g
Saturates
1.5g or less
1.6g–5g
More than 5g
Salt
0.3g or less
0.31g–1.5g
More than 1.5g
Type 2 diabetes 2013
”
With both
labelling systems,
check the
manufacturer’s idea
of a portion size
(given in grams), as it
may be different
to yours.
food labelling
top
GDA labelling
tips
Guideline Daily Amounts are what
an average adult of normal healthy
weight should eat per day. How
much we need depends on age,
weight and activity levels (see Table
2, below, for recommendations).
GDA labelling shows the amount of
calories, sugar, fat, saturated fat and
salt per portion of the product, and
then expresses it as a percentage
of the total amount of nutrient that
is recommended each day as a
healthy, balanced diet (see Table 3,
below). This is useful for helping you
decide how a particular food fits
into your overall diet.
In 2013
the government
will be recommending
a consistent system
of food labelling,
including traffic light
colours, text and
percentage
GDA.
Sugars
Fat
Saturates
Salt
Women
2000
90g
70g
20g
6g
Men
2500
120g
95g
30g
6g
Table 3: Example of GDA labelling
116
6
%
11g
12
%
Saturates
1
2
%
Amount in
product
help you decide whether
the product contains
‘a little’ or ‘a lot’ of fat,
sugar, salt and fibre.
• Use the ‘per 100g’
a guide as to how much
nutrient is in your food
or drink per 100g. Use
this to check against
your actual serving size.
• The figures for sugar
don’t tell you how much
of the sugar comes from
natural sugars, eg fruit
sugar (fructose) and how
much comes from added
sugars (sucrose).
• To see whether a product
Fat
0.9g
• Looking at the label can
• Table 3 (bottom) gives
Calories
Sugars
Reading
food labels
column on the label to
compare the make-up
of similar food and
the ‘per serving’ for
different foods.
Table 2: Guideline Daily Amounts (GDAs) of calories and
nutrients recommended for a healthy, balanced diet
Calories
FOOD
0.5g
%
Salt
0.3g
6%
% of adult
Guideline Daily
Amount
is high in added sugar,
look at the ingredients
list, which always
starts with the biggest
ingredient first.
• Remember that you don’t
need to avoid all food
and drink that contain a
lot of fat, sugar or salt.
It’s the overall balance of
your diet that counts.
2013 Type 2 diabetes
41
FOOD
food labelling
decoding
FOOD LABELS
The following key words will
feature on your food label.
Let’s look at them in more detail:
Energy
• The amount of calories (Kcal)
that a food or drink provides.
• To keep to a healthy weight, the
energy provided by your food
and drink must be in balance
with the energy you use.
Fat
• There are two main types of fat:
saturated and unsaturated
(polyunsaturated and
monounsaturated) fats.
• Reduce your total fat intake
– particularly saturated fat
as it is linked to heart disease.
Choose unsaturated fats
and oils, especially
monounsaturated fat, as these
fats are better for your heart
(see p34, point 3, for examples).
• Eating less fat helps you lose
weight. Being a healthy weight
helps your diabetes control.
Carbohydrate
• The figure for total carbohydrate
includes carbohydrate from
sugary and starchy food
and drink.
• Carbohydrate (of which
sugars) tells you how
much sugar is present and
includes both added
sugar and natural sugar.
• Added sugars include
sugars such as sucrose,
glucose, glucose syrup,
42
Type 2 diabetes 2013
invert syrup, maltose and honey.
The nearer they are to the top of
the ingredients list, the more
likely the food or drink is high in
added sugars.
• All carbohydrate increases
your blood glucose levels.
• Intense low-calorie sweeteners
such as Splenda, Canderel and
Hermesetas can be a useful
alternative to sugar.
• Regular meals, which include
some starchy food, will help
to control your blood
glucose levels.
Fibre
• Also known as ‘roughage’
(plant matter that your body
can’t digest).
• There are two types of fibre,
soluble and insoluble – both
are beneficial to your health.
• Soluble fibre, found in
beans, pulses, oats, fruit and
vegetables, helps to regulate
your blood glucose and
cholesterol levels.
• Insoluble fibre, found in
wholegrain cereals and breads,
beans, fruit and vegetables,
helps to keep your digestive
system healthy.
What to look
out for
1
Salt
You may see ‘sodium’ listed
on the label, rather than salt.
To convert sodium into salt
you need to multiply the
measurement on the label
by 2.5.
2
Reduced and low fat
It’s important to realise these
don’t mean the same thing.
Low fat means a product has
3g or less fat per 100g, while
reduced fat means a product is
25 per cent lower in fat than the
standard product. Often these
foods are high to start with, for
example mayonnaise, cheese
and crisps. You still need to
limit how much you eat, as
the reduced version is likely
to still be high in fat.
3
Portion sizes
A manufacturer’s idea of a portion
size might be smaller than yours.
A product may look healthy, but
even with healthier choices –
if you eat large portions – you
may end up consuming more
calories than you need.
4
Hidden sugars
Sugar isn’t always listed in the
ingredients as ‘sugar’. Look out
for the following terms: sucrose,
glucose, fructose, maltose,
honey, palm sugar, hydrolysed
starch, syrup and inverts sugar.
Remember the higher up sugar
is on the ingredient list, the more
added sugar the product has.
Ready
STEADY
Shop!
A selection of items from Diabetes UK.
All funds raised come to the charity.
new balance trainers
Exciting range of New Balance trainers.
For information on size, colour and width,
please call 0800 585 088. Alternatively,
go to http://shop.diabetes.org.uk
Carbs & Cals
An easy-to-understand
visual guide to carb and
calorie counting in diabetes
management. Contains
more than 1,700 photos of
popular food and drink
items, with the carbohydrate
and calorie values clearly
displayed above each photo.
£14.99+p&p
(code 4352)
Quick
cooking for
Diabetes
This book contains more
than 60 recipes that can
be cooked in 30 minutes
or less. Also includes
information on the
Glycaemic Index rating
and day-to-day menus.
£5.99+p&p
(code 3020)
badges
Beautifully crafted
badges – choose from
two different fastenings:
Broach fastening
£1+p&p
(code 4202a)
Butterfly fastening
£1+p&p
(code 4202)
Order these and other Diabetes UK items at http://shop.diabetes.org.uk
or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote TT2
when placing your order. (Postage is charged on some items.)
2013 Type 2 diabetes
43
FOOD
EATING IN
RECHARGE
YOUR
RECIPES
There’s no need to throw
out recipes that you know and
love... But making some small
changes will have you cooking
up a healthier version in no time
W
hether it’s your favourite
home-made pudding or
a comforting casserole, you
may have some tried-andtested recipes that you still
want to enjoy – but there may
be simple ways to make them
healthier. And, by following
these tips you can cut down
on the sugar, fat and salt in
your cooking, yet still keep
the flavour. Remember that
you don’t need to change
your recipes when eating
for special occasions.
Sugar
•
xperiment by using less sugar in your baking recipes. Most
E
cakes will work even if the sugar in the recipe is cut by a half.
Recipes such as fruit cakes, fruit scones or teabreads can be
made without added sugar, as they don’t need sugar for bulk
and the dried fruit will provide sweetness.
Recipes using a reduced
amount of sugar won’t
keep as long as traditional
recipes, as sugar is a natural
preservative. To avoid
wastage, freeze in portions
– remember to check
that the recipe is suitable
for freezing.
When making jams and
marmalades, ordinary sugar
will do, but try to reduce the
ratio to 1lb fruit to ½lb sugar.
Use sweeteners to add
extra sweetness.
•
•
•
44
Type 2 diabetes 2013
EATING IN
healthier AFRICAN &
CARIBBEAN cooking
Fat
•
•
•
•
•
•
FOOD
se low-fat dairy products
U
where possible, such as
skimmed milk, reduced-fat
cheeses and low-fat yogurts.
Try using stronger cheese
for cooking. You’ll find that
you won’t have to use as
much to get a good flavour.
Grated cheese tends to go
further, too. You can also try
reduced-fat varieties.
Use pulses such as peas,
beans or lentils in soups and
salads or to replace some
of the meat in shepherd’s
pie, casseroles and lasagne.
They’re low in fat and high
in fibre.
Choose lean meat, poultry
and fish as lower-fat
alternatives to fatty meats.
Remove any visible fat and
skin from poultry before
cooking and throw it away.
Grill, bake, poach, steam or
boil foods, rather than
cooking with added fat.
Reduce the amount of oil you
use – measure it out properly
and don’t just pour. Avoid
foods sticking to the pan by
cooking on a low heat and
stirring often, using a nonstick pan and a low-fat spray,
or using a splash of water.
•
•
•
•
•
•
kim the fat from the top of
S
curries, casseroles and stews.
Watch out for creamy sauces
and dressings and swap for
tomato-based sauces.
Light crème fraiche is not
heat sensitive and so is ideal
for use in savoury sauces.
It’s also delicious served on
hot or cold puddings instead
of double cream.
Fromage frais is fresh
skimmed milk cheese, but is
more like a natural yogurt. It’s
sensitive to heat, so is best
used in cold desserts and
dips in place of cream or
Greek yogurt.
When you feel nothing
but cream will do, spoon
extra-thick single cream on
to fruit or puddings and use
whipping cream for filling
cream buns or cakes instead
of double cream.
Try using filo pastry instead of
normal pastry and spread
with beaten egg in-between
the sheets instead of butter.
Salt
•
educe the amount of salt
R
and try spices and herbs for
added flavour.
• U
se less saturated fat, such
as palm oil, coconut oil
and butter.
• Grill, steam or oven bake
foods such as jerk chicken,
jerk beef, corn and
pineapple fritters.
• Cutting down on foods such
as sugar cake, sweet potato
pie, duckunoo, pudding and
condensed milk can be an
easy way to reduce the sugar
in your diet.
• Choose healthier ways of
cooking plantains, fish,
breadfruit, yams or dumplings,
such as baking, grilling, boiling
or poaching.
• Avoid refrying leftovers.
healthier South
asian cooking
• A
dd millet or chickpea flour
to chapatti flour to make it
lower in GI.
• Avoid adding (or reduce
the amount of) fat or oil
when making chapatti dough.
• Try using unsaturated fats,
such as rapeseed or
sunflower oil instead of ghee.
• You can make low-fat
paneer using skimmed or
semi-skimmed milk.
• Use less coconut cream
or coconut milk, or try a
reduced-fat version.
• Limit pickles with your meals.
• Cut back on snacks, such as
chevda and try plain popcorn
or roasted corn instead.
• Roast your poppadoms
instead of frying them.
2013 Type 2 diabetes
45
FOOD
EATING OUT
Out &
about
When you’re on the
go, eating out is a
great option. But if
you do this a lot, it’s
worth thinking about
healthier choices
W
e live in a convenience
culture where it’s relatively
easy to find ready-made meals
and takeaways. And a large part
of socialising revolves around food,
such as dinner parties and eating
out. These meals may be higher
in fat, sugar and salt and you may
enjoy portions larger than you
would normally eat at home. But
eating out should be enjoyable.
Taking time for your meal, whether
eating on the go or in a restaurant
will make you more aware of what
you are eating and drinking (and
therefore less likely to overindulge).
This section is aimed at people
who eat out regularly and are
interested in finding some ways to
do so more healthily – especially if
there is no nutritional information
available. Eating out doesn’t need
to be at the expense of your health.
46
Type 2 diabetes 2013
MEAL DEAL, NO DEAL
Try to avoid offers that
encourage you to buy
fattening crisps or sugary
drinks. Likewise, resist the
temptation to ‘supersize’
unless you know that your
lifestyle allows the extra
calories, as most triple-decker
sandwiches contain 500– 600
calories – around a quarter
of your GDA.
BURGER CHAINS
Burgers are a quick and easy
option when you’re on the go,
but you could cut down the
fat by asking for no
mayonnaise and going
easy on the cheese. Cut
the calories by choosing a
‘bun-less’ burger
and order
extra salad
– but keep
an eye on
the dressing.
CURRY DISHES
These are high in fat, but tandoori and tikka options are baked
and tend to be lower in fat. Dahls are good providers of fibre
because of the lentils and pulses, but can still be quite oily.
Choose boiled or steamed rice, rather than pilau or fried
rice. Watch out for the extras you order, such as poppadoms
and naan breads.
EATING OUT
FISH AND CHIPS
Try and order a smaller portion, or even remove
some of the batter. Thicker-cut chips tend to
be a little lower in fat as the thicker the chip, the
less fat it absorbs during cooking.
DRINK WELL
If you’re watching your
weight, remember that some
‘healthy’ fruit smoothies
contain added sugar, honey,
yogurt or milk that can bump
up the calories, fat and sugar
content. Even some fruit juices contain
added sugar, so check the
label before you buy.
CHINESE, THaI AND MALAYSIAN
These dishes are often high in calories, fat,
salt and sometimes sugar. Soups are often
preferable starters over prawn crackers and
spring rolls, and choose boiled or steamed
rice and noodles as the accompaniment for
your main meal.
CHECK YOUR SALADS
You may think choosing a salad is a safe bet,
but many are swimming in high-fat dressings
that bump up the calorie and fat content
considerably. Ask for the dressing on the side
so that you can decide how much
to add. Take a look at the
ingredients and
remember that they
are listed from the
highest-quantity
ingredient first to
the lowest-quantity.
FOOD
Sometimes my blood
glucose levels are higher
than normal when I’ve
eaten out. Why is this?
At some point, whether you’re eating more
than usual or different foods at a restaurant,
from a takeaway or over festive periods, you
may find that your blood glucose levels are
higher than normal. Being less active,
overindulging or changing your routine could
be the reason. The odd one or two high
glucose readings shouldn’t affect your
long-term diabetes control or health.
Q& A
Do I need to make changes to my
diabetes medication when eating out
or eating at a later time than normal?
A change in your usual routine and diet when
eating out needn’t have an effect on your
diabetes control. For example, if you are on
twice-daily insulin injections and eating lunch
later than usual, you may need to have an
extra snack before your meal. Doing this will
help to prevent a hypo. If it’s an evening meal
that you are having later than usual, it may be
possible to simply delay the timing of your
evening insulin to when you start your meal.
If you are on a basal bolus insulin regimen, it
can be easier to vary the timing of all meals –
you take your bolus insulin when you eat.
Your diabetes team will be able to give you
specific information on how to adjust the
timing of your medication and/or insulin and
how much to take.
Is it a good idea to do some sort of exercise
after eating?
Some form of activity after a meal will help to
use up the extra energy you have eaten and
help to control your blood glucose levels. A
brisk stroll after lunch and dinner will make all
the difference and get rid of that sluggish
feeling you may have after a heavy meal. Ask
your friends and family to join you, as they’ll
benefit too – not just those with diabetes.
2013 Type 2 diabetes
47
FOOD
EATING OUT
PIZZA
This can be very high in fat and salt, so
choose your portion sizes and toppings
carefully. Ordering thin bases and extra
side salad could help to reduce some
of the calories.
SLIMLINE SANDWICHES
These are healthier lunch options with
low-fat spreads and dressings replacing
high-fat mayonnaise, margarines and
coleslaw. Healthier fillings include: lean
ham, chicken, turkey, fish or egg instead
of fatty bacon, cheese, sausage or stuffing.
Choose grainy breads and sandwiches or
wraps with salad to help
bump up your fibre
intake and help
you feel fuller
for longer.
HEALTHIER SNACKS
Choosing vegetable crudités and fruit for
snacks can help you to meet your ‘five a
day’ target. Low-fat yogurts are also a
good choice and an easy way to add
bone-strengthening calcium to your diet.
We all know that regular crisps are high in
fat, so instead of going for these, choose
oven-baked or lower-fat varieties, or
individual packs of air-popped popcorn
– though be aware that these are still
relatively high in fat, salt and calories.
Individual cake bars, although tempting,
are full of calories, fat and sugar.
Even ‘skinny’ muffins and cakes
contain 300–400 calories, which is
more than many chocolate bars.
Individual slices of malt loaf, fruit loaf
and tea cakes are healthier alternatives.
48
Type 2 diabetes 2013
DIABETES
PEER
SUPPORT
Connecting people with diabetes
to share experience and support
LIVING WITH DIABETES?
NEED TO TALK?
We all have questions. Your calls and emails are
answered by trained volunteers with first-hand
experience of diabetes. Our service is for everyone
living with diabetes.
Wednesday
Thursday
Friday
Sunday
12–3pm and 7–10pm
7–10pm
9–12 midday and 7–10pm
7–10pm
0843 353 8600 quoting PSTES1
www.diabetes.org.uk/peer-support
A charity registered in England and Wales (215199)
and in Scotland (SC039136). © Diabetes UK 2013
Get
involved
Become a member
0845 123 2399
Join our 300,000 supporters who help us care for,
connect with and campaign on behalf of all people
affected by and at risk of diabetes.
Raise Your Voice
www.diabetes.org.uk/
diabetesvoices
Join Diabetes Voices and make a difference
to services and care by working alongside us
to campaign and influence for change.
Volunteer
www.diabetes.org.uk/
volunteering
Whether you can spare an hour a month or a day
a week, there are many ways that you can make a
difference at Diabetes UK.
Raise funds
www.diabetes.org.uk/
fundraising
There are many ways you can raise funds or give
to Diabetes UK. Visit our website to find out how
you can help us to improve the lives of people
with diabetes.
CALL OUR CARELINE
0845 123 2399
A free and confidential service offering information
on living with diabetes and giving people the
opportunity to talk things through.
GET SUPPORT FROM PEERS
0843 353 8600
A helpline and email service delivered by specially
trained volunteers who have first-hand experience
in living with diabetes.
JOIN A Voluntary group
voluntarygroups@diabetes.
org.uk
Our local support groups offer the chance to share
experiences with others in your area and keep up
to date with our work.
GO online
www.diabetes.org.uk
Our website offers information on all aspects of
diabetes and access to our activities and services.
and twitter
communities
Our facebook
provide support and a chance to talk to others.
Get
support
2013 Type 2 diabetes
49
FOOD
ALCOHOL
Party
on
down
You can still enjoy
an alcoholic drink
with diabetes.
Here’s how to
keep safe
W
hen you’re having fun, it can
be easy to get carried away
and not notice how much alcohol
you’re drinking. But, whether you
have diabetes or not, government
guidelines recommend a limit of
3–4 units a day for men, and 2–3
units per day for women.
Hypos
Drinking alcohol makes
hypoglycaemia (low blood glucose
– ‘hypos’) more likely for people
who treat their diabetes with insulin
or certain tablets such as
50
Type 2 diabetes 2013
sulphonylureas. It also slows down
the release of glucose from the
liver, and glucose is needed if you
have a hypo.
If you have too much alcohol,
you might not be able to recognise
a hypo or treat it properly. Other
people can mistake a hypo for
drunkenness, especially if you smell
of alcohol. It’s important to tell the
people you are out with that you
have diabetes, and what help you
might need if you have a hypo.
Also, make sure you carry some ID
to let others know that you have
diabetes, such as an ID card,
medical necklace or bracelet.
If you drink more than a few units
in an evening, you will have an
increased risk of hypos all night and
into the next day, too, as your liver
continues to get rid of the alcohol.
Always have a starchy snack, such
as cereal or toast, before going to
bed to help minimise this risk.
The morning after
If you end up having one too many,
despite your best intentions,
drinking a pint of water before you
FOOD
ALCOHOL
How
many
units?
Can (440ml)
lager, beer
or cider
(5% ABV)
2
1 pint lowerstrength lager,
beer or cider
(3.6% ABV)
1 pint higherstrength lager,
beer or cider
(5.2% ABV)
3
2
Bottle (330ml) lager,
beer or cider
(5% ABV)
1.7
Small glass
(125ml) white,
rosé or red wine
(12% ABV)
1.5
Large glass
(250ml) white,
rosé or red wine
(12% ABV)
Pub measure
(25ml) spirit,
eg vodka, gin,
whisky (40%
ABV approx)
1
3
Bottle (275ml)
alcopop
(5.5%
ABV)
go to bed will help to keep you
hydrated and may help to
prevent a hangover.
If you do wake up with a
hangover, you’ll need to drink
plenty of water. And if you are
suffering the typical hangover
symptoms of headache, nausea,
shaking and sweating, check
your blood glucose level as you
may actually be having a hypo.
No matter how awful you feel,
you need to treat a hypo straight
away – don’t ignore it. Likewise,
you must stick to your usual
1.5
Medium glass
(175ml) white,
rosé or red wine
(12% ABV)
2.1
medication. Always have
some breakfast to aid blood
glucose control.
If you can’t face food, or if you
are being sick, take as much fluid
as you can, including some sugary
(non-diet) drinks. Painkillers may
help with a hangover headache,
but try to avoid them until your
liver has had time to recover.
Remember, the morning after
doesn’t have to feel like this –
try following our steps to safer
drinking, above, right.
i www.drinkaware.co.uk
top
Safer
tips
drinking
• Eat something
carbohydrate-based
before you drink, and
snack on starchy food
during the evening to
keep your blood
glucose levels up.
• Tell the people you are
with you have diabetes
and carry medical ID.
• Alternate alcoholic
drinks with loweralcohol or alcohol-free
alternatives.
• Pace yourself – enjoy
your drink slowly and
keep track of how
much you are drinking.
• Don’t forget to take
your hypo treatment
with you.
Carry some form
of medical ID so
that other people
know that you
have diabetes
”
2013 Type 2 diabetes
51
FOOD
Religious fasting
RELIGIOUS FASTING
Fasting forms a significant part of many religious faiths varying in timings,
durations and restrictions. Here’s how you can fast with diabetes
F
asting is an important spiritual
aspect of many religions, such
as Christianity, Islam, Hinduism and
Judaism. As well as the abstinence
from food (and sometimes drink),
fasting is also usually a time of
prayer, reflection and purification.
It is an opportunity for people to
adapt to a healthier lifestyle by
learning self-control and making
changes to their diet.
People with diabetes are
usually exempt from fasting,
although many may still choose
to fast. Speak to your religious
leader if you want information
about whether you are exempt
from fasting. Planning ahead and
speaking to your healthcare team
is the key to ensure that diabetes
control is not affected.
What happens to your
body during fasting?
Changes to the body during
fasting depend on the length of the
continuous fast. Usually your body
enters into a fasting state eight or
so hours after the last meal. Your
body will initially use stored sources
of glucose and then later in the
fast it will break down body fat to
52
Type 2 diabetes 2013
use as the next source of energy.
Using your body’s fat stores as an
energy source can, in the long run,
help to reduce your cholesterol
levels and blood pressure, as well
as your weight. Losing weight,
particularly if you are overweight
can also lead to better control of
you gain weight. Try using some of
the tips to adapt your recipes on
page 44. Additionally, drink plenty
of water or sugar-free and
decaffeinated drinks to avoid
dehydration. If you like sweet drinks,
use a sweetener instead of sugar.
ahead
“Planning
is key to ensuring
your diabetes
isn’t affected
during fasting
”
diabetes. However, fasting should
not be used as a way of losing
weight in the long term.
Changes to your diet
When you do eat during the fasting
period, your eating pattern and the
types of food and drink you have
may be very different compared to
normal. However, it is important to
keep to a balanced way of eating,
including food from all of the food
groups and to not eat excessively.
When you break the fast, only have
small quantities of sugary and fatty
foods, such as sweets, cakes, and
fried snacks – too many can make
ACTION
POINTS
•
•
•
•
peak to your diabetes
S
healthcare team, if you
are planning to fast,
for advice on adjusting
your medication and/or
insulin, testing and how
to avoid highs and lows.
Continue a varied and
balanced diet.
Try not to have too many
sugary and fatty foods
when you break the fast.
When you break the fast,
ensure you drink plenty
of water, sugar-free and
decaffeinated drinks to
avoid dehydration.
Questions & ANswers
Food
queries
solved
FOOD
Is it true that I shouldn’t eat
bananas or grapes?
No. All fruit is good for you. Eating
more fruit can reduce the risk of
heart disease, some cancers and
some gut problems. Eat a
variety of different fruit
and vegetables for
maximum benefit.
Can I still have some sugar in my diet?
Yes. Eating sugar doesn’t cause diabetes
and people with diabetes don’t need to have
a sugar-free diet. It’s ok to have foods
like chocolate and cakes
occasionally alongside a healthy
diet. But remember, sugary
foods provide empty
calories.
Is it ok for me to take a
vitamin supplement now
that I have diabetes?
Diabetes UK doesn’t recommend
that people with diabetes take a
supplement. If your diet is deficient
in some nutrients, then you may
benefit from taking one, but this
should be decided in conjunction
with your doctor and/or
dietitian. (Women with
diabetes should take a
supplement of 5mg
of folic acid when
planning pregnancy
and continue to take it until the
end of the 12th week of
pregnancy. This dose of folic acid
is only available on prescription.)
I’d like to use a sweetener instead of sugar
in my tea, but I’ve heard that they aren’t
safe. Is this true?
All sweeteners have to undergo rigorous safety
tests before they can be sold in the UK. The
government sets safe limits and surveys groups
of individuals to see whether they are exceeding
these limits. At the moment, there is no evidence
to suggest that the general public is exceeding
these safe limits, but if
you are at all concerned
you can minimise this
risk by using a variety
of sweeteners.
Can people with diabetes
follow a vegetarian diet?
Yes, although following a
vegetarian diet does not
necessarily mean a healthier diet.
You still need to have a good
balance of different foods. To
make sure you’re following a
healthy, balanced vegetarian diet,
visit The Vegetarian Society’s
website: www.vegsoc.org.
2013 Type 2 diabetes
53
HERE’S A WINNING WAY TO SUPPORT
THE WORK OF DIABETES UK!
WIN WEEKLY
CASH PRIZES
£12,500
£1,000
POT
JACK
YEAR
2 PER
RIZE
TOP P EEK
ERY W
EV
PLUS
CA
W
INNER
YO
SE
E
S
Y WE
AS
ER
SH T O
SPEND
K
U P LEA
100
E
V
ER
K
P
R
£1
E
V
F
LAY O
99
CASH PRIZES
EVERY WEEK!
Y WE
E
ENTER ONLINE NOW:
www.diabetes.org.uk/weeklylottery
CALL NOW TO ENTER:
You’ll find our full lottery
rules on the website.
01628 822 271 and quote ‘Jackpot’
Thank you so much for joining in.
A charity registered in England and Wales (215199) and in Scotland (SC039136).
weight management
Living with diabetes
WATCHING YOUR WEIGHT
Achieving your
ideal weight is
often easier said
than done. But
being overweight
makes diabetes
control difficult
Here we look at
the positive steps
you can take
to lose any
extra pounds
T
here’s a lot of evidence to
show that managing weight
(if you are overweight) is the most
important element of controlling
Type 2 diabetes. Losing some of
the weight has also been shown
to improve blood pressure and
blood fats (cholesterol). These
benefits will help reduce the risk
of developing any long-term
health problems.
There are three key essentials to
getting motivated and staying on
track. They are known as ‘WHY’,
‘WHAT’ and ‘HOW’
• Know WHY you are doing
something, as it will help
you to stay motivated and
keep you on track.
• Decide WHAT you are
going to do.
• Work out HOW you are going to
do it – do your homework, speak
to your dietitian (or ask your GP
to make a referral).
How do you know if you need
to lose weight?
There are several ways you can
measure yourself to find out if you
are overweight:
• Calculate your BMI (Body Mass
Index). BMI looks at a person’s
weight in relation to their height.
This will give you an idea of what
range your weight is in. Find out
your BMI using the BMI chart
(see p57). Find the point where
your height and weight meet on
the chart to see what range your
weight is in. (Weight classification
is slightly different for people of
South Asian origin and these
2013 Type 2 diabetes
55
Living with diabetes
Weight management
your weight is the most important
“ Managing
element of controlling Type 2 diabetes
”
ranges are outlined on the table.)
• Measure your waist: You
can measure your waist
circumference, which shows
the amount of weight you carry
around your waist. If you need
to lose weight, reducing your
waist size will help to improve
blood glucose control and reduce
Staying
on track
top
tips
Feeling like you’ve hit a
brick wall? Here’s how you
can stay motivated and
committed to your weightloss plan:
•See it through.
• Know your goals.
•Be prepared – think ahead.
•Overcome obstacles.
Think about what might
stop you and devise a
game plan.
See how far you have
come – take time to
assess your progress.
Visualise your success
– see it, feel it and
remember it.
•
•
56
Type 2 diabetes 2013
your risk of developing long-term
health problems. To measure
your waist, find the bottom of
your ribs and the top of your hips.
Measure around your middle at
a point midway between these
(for many people this will be
the tummy button). Guideline
measurements are:
• White and Black men:
below 94cm (37in).
• South Asian men:
below 90cm (35in).
• White, Black and South
Asian women: below
80cm (31.5in).
How much weight
should I lose?
Ideally, you should aim for a target
weight that gives you a BMI in the
normal weight category (see chart,
above right), but if you have a
considerable amount of weight
to lose, this may seem extremely
daunting and impossible to
achieve. Instead, you may prefer
to set an initial weight loss that
moves you down a couple of BMI
notches, or perhaps shifts you from
one category to another. Research
shows that losing just 10 per cent
of excess weight will improve your
health – and you can always set
new goals along the way.
On the other hand, you may
already be in the normal range
category. But if your weight is
gradually increasing, now’s the
time to act and shift those kilos
before you end up becoming
medically overweight.
While many of us might like
to slim down to a weight we were
when we were 18, it’s important to
be realistic about whether you can
really achieve this. For most of us,
this may not be practical. It’s better
to focus on reaching a target
weight that leaves you looking
and feeling slim, fit and healthy.
Once you’ve decided on a
realistic weight goal, you’ll be able
to work out how long it will take
to reach this.
If you are aiming to shed some
weight, you will need to be aware
of your daily calorie intake – and
reduce it (a calorie – Kcal – is a unit
of energy).
What’s this about calories?
The body uses energy not only for
exercise, but also for everything we
do (even breathing and sleeping).
The Guideline Daily Amount (GDA)
of calories needed per day is 2,000
for women and 2,500 for men (to
replace the energy used and to
maintain a healthy weight).
However, these recommendations
are for the average adults of normal
Living with diabetes
Weight management
How long should it take?
A safe and achievable target is to
lose 1–2lb (0.5–1kg) a week. To
lose around 1lb a week, you will
need to consume 600 less calories
per day than your body needs to
maintain weight. This is because
there are around 3,500 calories
in 1lb of body fat, so it will take
around six days to lose it.
Increasing your physical activity
will help you to burn off more
calories and lose weight more
quickly. Beware of cutting calories
too low, as this can put your
health at risk.
You may lose more weight
in the beginning as your body
gets rid of water, as well as fat.
In the long-term, though, weight
loss of more than 2lb a week
means that you have seriously
ese
Mo
rbi
dly
ob
es
e
Ob
Height in metres
1.91
1.88
1.85
1.83
1.80
1.78
1.75
1.73
1.70
1.68
1.65
1.63
1.60
1.57
1.55
1.52
1.50
1.47
ight
Ove
rwe
ight
Hea
lthy
we
und
erwe
6’3
6’2
6’1
6’0
5’11
5’10
5’9
5’8
5’7
5’6
5’5
5’4
5’3
5’2
5’1
5’0
4’11
4’10
ight
38
44.5
51
57
63.5
70
76.5
82.5
89
95.5
102
108
115
121
127
134
140
146
153
159
Weight in kilograms
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
healthy weight. How many calories
you need per day can vary greatly
depending on your lifestyle, age,
height, weight and level of physical
activity. If you consume more
calories than you need, the excess
will eventually turn to fat, causing
weight gain. But if you consume
fewer calories than you need, you
will lose weight. So, in a nutshell,
you need to consume fewer
calories than you are burning off
if you want to lose weight.
Height in feet and inches
1ft=0.3m
(approx)
1lb=0.45kg
(approx)
Weight in stones
Underweight
Healthy weight
Overweight
Obese
Morbidly obese
BMI
up to 18.4
18.5–24.9
25–29.9
30–39.9
40 or more
South Asian adult
less than 18.5
18.5–22.9
23–24.9
25–34.9
35 or more
To calculate your BMI:
weight (kg)
height (m) x height (m)
So, if you’re
1.80m tall and
95kg, your BMI
would be 29
slashed the calories – and
ultimately this makes it harder for
your body to lose weight. Very low
calorie intakes push your body into
starvation mode and it preserves
the fat stores for when it really
needs them – and uses muscle
tissue instead. The loss of muscle,
results in the body slowing down
the metabolism so that it needs less
95
(1.8 x 1.8)
= 29 (BMI)
food and drink to keep it going
– not ideal if you are wanting to shift
unwanted weight.
What works?
There are many approaches to
losing weight – there’s no quick
fix or one-size-fits-all approach.
Evidence shows that for successful
long-term weight loss, small and
2013 Type 2 diabetes
57
Living with diabetes
Weight management
ACTION
POINTS
realistic changes are crucial, as well
as sticking to a slimming plan that
you enjoy and fits in with your life.
It’s important the eating plan is
balanced – low in saturated fat, salt
and sugar, and contains fibre. And
regular exercise is good for both
your waistline and health –
especially your heart. See p32 for
more information on a balanced
diet, including portion sizes.
Eating more healthily and leading
a more active lifestyle isn’t easy
for everyone. You may need
more support and choose to
join a weight-loss programme
Commercial weight-loss
programmes are likely to involve
one or a combination of:
• calorie controlled weight-loss
eating plan
• individual, group or online support
• meal replacements, such as
milkshakes, ready meals or bars
• psychological support.
Q& A
It is important that the programme
provides support and education
to ensure that the weight loss
you are promised is realistic
and sustainable. You need to
make sure it follows healthy
weight-loss guidelines.
What should I look for in a
weight-loss programme?
Ask yourself the following:
• Is the weight loss
offered realistic?
• Does the programme
provide complete nutrition
(or nutritionally adequate)?
• Does the programme give
support and education?
• Has a healthcare
professional been involved?
• Does the programme offer advice
on your diabetes (especially if you
are at risk of hypoglycaemia)?
Remember to let your diabetes
team know if you are starting
Can I exercise more, instead
of watching what I eat?
Physical activity on its own will only lead to weight loss if you do at
least 60 minutes a day, and evidence shows that combining physical
activity and diet will lead to the biggest weight loss. Physical activity,
regardless of weight loss, leads to improvements in blood pressure,
blood fats and glucose levels and has positive effects on heart health.
I am extremely overweight and feel like I need
to do more than eat healthily. What can I do?
For some people with diabetes, weight loss medication and surgery
may be a good option. To find out more about whether these are
right for you, talk to your GP or diabetes healthcare team.
58
Type 2 diabetes 2013
• Calculate your BMI.
• Set a realistic target weight.
• Work out how long it
will take.
• Decide on a slimming plan.
Once you’ve set a realistic
target weight and know
roughly how long it should
take, you can devise a
slimming plan that will
work for you.
a programme, as it may affect
your blood glucose levels and
medication.
How will losing weight
affect my diabetes?
If you manage your diabetes with
insulin and/or tablets you may
need your doses to be adjusted
as you lose weight and become
more active.
Your diabetes healthcare team
can advise you about any
changes to your medication,
and your dietitian can help you to
design a weight-loss programme
that works for you. If you haven’t
seen a dietitian, ask your GP
to make a referral.
Weight management
Living with diabetes
How to set your weight-loss goals
First, make sure your goals are realistic. Write them down. Assess and review them regularly
– and make sure that you celebrate your successes. Here is an example of a long-term goal:
What’s my
motivation for
losing weight?
I want to be
healthy and be
able to play with my
children.
How much
weight should I
aim to lose?
I’d like to
lose 1 stone in
the next year – 10
per cent of my
body weight.
Instead of crisps
every day, I’ll have
a piece of fruit on at
least five days a What action
week.
will I take?
How
will I achieve
this?
I will
take a piece
of fruit to work
each day.
I’ll start on
Monday, once I’ve
done my weekly
shop
What
do I need to
do to make this
happen?
I’ll
buy fruit
and veg that
are in season and
on special offer
each week.
When
will I start?
How
will I monitor my
success?
I will
start a diary
with my three goals
and tick each day that
I achieve them.
2013 Type 2 diabetes
59
Living with diabetes
Calorie swaps
Swap ’n’ save
If you want to cut back on calories, here are some
suggestions and savings you can make to your daily routine
Breakfast
Tall (12 fl oz)
semi-skimmed
latte
150Kcal
2 medium slices
of toast, 70% fat
margarine (20g)
and jam (30g)
345Kcal
Save
60
calories
Save
175
calories
Tall (12 fl oz)
cappuccino
with semiskimmed milk
90Kcal
2 wheat biscuits
and 85ml
semi-skimmed
milk
170Kcal
Lunch
Prawn mayo
sandwich
350Kcal
60
Save
50
calories
Save
Low-fat prawn
mayo sandwich
300Kcal
Packet of
crisps (30g)
160Kcal
100
1 medium
pear
60Kcal
Standard size
chocolate bar (55g)
280Kcal
Save
2-finger
chocolate
wafer biscuit
105Kcal
Type 2 diabetes 2013
calories
175
calories
Calorie swaps
LivingTESTIN
with diabetes
Dinner
2 grilled pork
sausages (110g)
324Kcal
Bakewell tart
140Kcal
Snacks
High-street coffee
shop skinny
blueberry muffin
370Kcal
Medium slice
of flapjack
(60g)
300Kcal
Save
183
calories
Save
85
calories
Save
275
calories
Save
200
calories
Save
2 chocolate
digestive biscuits
170Kcal
70
calories
Small roasted
chicken breast (95g)
141Kcal
100g pot of
low-fat yogurt
55Kcal
High-street coffee
shop portion of fruit
salad
95Kcal
Medium
slice of malt
loaf (35g)
100Kcal
Medium banana
100Kcal
Alcohol
Glass of medium dry
white wine 175ml
130Kcal
Save
75
calories
1 single (25ml)
measure of vodka and
slim-line tonic water
55Kcal
2013 Type 2 diabetes
61
Living with diabetes
PHYSICAL ACTIVITy
Moving on up
Being active is not only great for your
health, it can also make you feel more
positive and give you more energy
62
Type 2 diabetes 2013
Living with diabetes
PHYSICAL ACTIVITy
P
hysical activity is an important
part of your diabetes
management. It can help to improve
blood glucose, as well as improve
fitness, prevent excess weight gain,
keep the heart healthy and lower
blood pressure. It also improves
self-esteem and reduces the
symptoms of depression and
anxiety. The Department of
Health recommends:
• Adults should aim to be active
on a daily basis.
• Working towards a target of at
least 150 minutes (2½ hours)
over the course of a week.
Moderate intensity activity can
be done in bouts of 10 minutes
or more, so you could aim for
30 minutes a day on at least
five days a week.
• If you choose to do vigorous
intensity activity, then 75 minutes
can be spread across the week.
• Include activities that increase
your muscle strength at least
twice a week.
What is moderate intensity?
This causes you to feel warmer,
breathe harder and your heart to beat
faster, but you should still be able to
hold a conversation. Examples are
brisk walking and cycling.
What is vigorous intensity?
This causes you to feel warmer,
breathe harder and your heart to
beat faster but it would be difficult
to hold a conversation. Examples
include running, swimming or
playing sports, such as football.
What is musclestrengthening activity?
This involves using body
weight or working against
resistance. Examples are:
dancing (stepping or jumping),
exercising with weights or carrying
or moving a heavy load, such as
food shopping.
If possible, get into good habits,
such as cutting down the time you
spend in sedentary (sitting)
activities, such as watching TV,
playing electronic games or
using the computer. The time
spent in these activities could be
interspersed with action, even
just doing some stretching
exercises or running up or down
the stairs.
As time goes by
As you grow older it may not be
as easy to be physically active,
but even if you can’t reach the
government targets, remember that
some activity is better than none as
it helps your ‘feel good’ hormones.
To improve your balance and
co-ordination try Yoga or Tai Chi.
If you are unable to stand, then
try to do some exercises while
sitting in your chair, eg gentle
stretches, leg and arm raises,
and neck exercises. These can
also be done from your bed or
a wheelchair.
Movement can help keep the
mobility you have and even increase
it. Your GP may be able to refer you
to a physiotherapist who can help
you or a local exercise programme.
top
tips
Increasing
activity
1
2
Use stairs instead
of a lift or escalator.
3
4
Cycle or walk short
journeys, rather than
using the car.
Get off the bus or tube a stop earlier.
Use your lunch
break to go for a
brisk walk.
5
If you’re in a sedentary
job, try to get up and
walk about regularly.
6
7
Walk a dog regularly.
T
ake up swimming
or playing golf.
Remember, all activity
counts, but try to vary the
type of activity you do so
that you don’t get bored.
2013 Type 2 diabetes
63
Living with diabetes
PHYSICAL ACTIVITy
Keep it safe
Staying motivated
Many people start out with great
determination but soon find they
lose interest or the determination
to continue. So it’s important to:
• Find an activity you enjoy and
you will be more likely to keep
it up. Better still, try taking up
an activity the whole family or
your friends can enjoy.
• Set yourself daily, weekly and
monthly targets.
• Keep a physical activity diary
to track your progress and
celebrate your successes.
• Keep it exciting by trying
new activities.
64
Type 2 diabetes 2013
taking up an
“Try
activity the whole
family or your friends
can enjoy
”
Before you start any new
activity check with your
diabetes healthcare team
if you:
• are taking diabetes or
heart disease medication
• have any complications
of diabetes like foot or
eye problems
• are not sure which
activities suit you
• have any conditions that
may restrict your mobility
or ability to be active, eg
high blood pressure,
angina, osteoporosis,
asthma or have had a
heart attack.
This is general information,
talk to your diabetes
healthcare team for
individual advice.
PHYSICAL ACTIVITy
Living with diabetes
top
tips
Physical activity
1
2
3
4
5
Warm up before exercise and have a
period to cool down afterwards.
Wear the right footwear during activity.
Speak to your podiatrist if you are not sure.
Keep your feet dry and inspect them before
and after the activity.
W
ear diabetes ID such as an identity
card, bracelet or necklace.
Drink fluids regularly to avoid dehydration.
Increasing your activity levels can
be combined with a social event
Photo: James Clarke
Q& A
I want to keep fit but the gym and even going for a swim
is very expensive. What can I do?
Many GP surgeries offer ‘exercise on prescription’. You’ll be referred
to a local active health team for a fixed number of sessions under
the supervision of a qualified trainer. You decide with your
GP and the active health team what type of activity will suit you.
Depending on your circumstances and what’s available, the
exercise programme may be offered free or at a reduced cost.
Will I have a hypo if I do lots of exercise?
If your diabetes is treated with certain diabetes medication or insulin,
then you may be at risk of a hypo if you do intense exercise for a
period of over an hour. Discuss this with your diabetes healthcare
team. You may need to check your glucose levels before and
during the exercise and to keep some fast-acting glucose, such
as a non-diet drink, close by.
ACTION
POINTS
• Take advice from your
diabetes healthcare team
on the types of activity
most suitable for you.
• Try to increase your activity
levels by introducing some
simple activities at first
and increasing duration
and intensity.
• If you belong to a gym, the
fitness instructors need to
know about your diabetes
so they can carry out a
health review.
2013 Type 2 diabetes
65
Living with diabetes
Accepting diagnosis
Take time to adjust
Being diagnosed with diabetes isn’t the best news you have ever received or the
easiest to fully understand initially. As Jane Matera from Diabetes UK Careline
explains, you, and those close to you, will need some time to absorb the news
Talk about your feelings
with friends and family
O
n the face of it, the diagnosis
of Type 2 diabetes seems
straightforward.
A doctor looks over pages of
test results, and says, almost by
the way, “Oh. Did you know you
had diabetes?” Or maybe you’d
been to the surgery with what
seem innocently-other symptoms:
a recurring infection; extreme
tiredness, and now the results have
shown this.
Your busy doctor is probably
already clicking into routine: book
appointment for nurse/dietitian/eye
scan. HbA1c in three months.
66
Type 2 diabetes 2013
You may accept this and it might
not have come as a surprise, but
on the other hand, it may be a
shock and you may feel as if you’ve
seemingly walked into the surgery
as a person you know, and walked
out as someone else altogether.
Out of the blue
Being diagnosed with any
long-term condition can come
much like a bereavement. As with
bereavement, whether it comes
as a bolt out of the blue or whether
it’s half-expected, it still comes as a
shock. There may be fear. There may
be a sense of anxiety, ‘What does
this mean for me?’ And meanwhile,
your diagnosis is possibly being
treated in a very matter-of-fact
way that, if anything, confuses
you even more. Nobody is really
acknowledging the emotional shock,
they’re too busy with the practical.
Friends may minimise it. “What are
you so fussed about? It’s only
Type 2,” they may say. “You don’t
have to inject, do you? Well then.”
This is the point at which many
people call the Diabetes UK Careline.
They want to know what to do.
Two things help enormously:
Accepting diagnosis
diagnosis may not have come
“Your
as a surprise, but on the other
hand, it may be a shock
”
• Get the right information
First of all, it’s important to have the
right information to understand your
diabetes better, so that you feel
reassured. This can be anything
from knowing what to eat to how
to take your medication.
• Talk to someone who’ll listen
Talking about what may have led
up to the diagnosis, how you were
diagnosed and how you are now
feeling is likely to give you
immeasurable relief.
The more you talk it through, the
more release you will experience.
The shock will slowly evaporate.
You’ll begin to gather up your own
strengths. The realisation that
others have gone through this
self-same experience may well also
be of benefit.
Patterns of coping
Be aware, if you’re not already,
that we all have learnt patterns
around how to deal with the great
difficulties of life; how to cope.
Yours may be one you’ve learnt,
through hard experience, to get
you through. Now might be a
good time to look at your pattern.
Denying a difficult reality,
ignoring it, or putting it to one
side is tempting, and it’s a totally
understandable reaction. You
might be thinking like this for
days, weeks, even longer after
diagnosis. But, where diabetes
is concerned, this can only
really be a short-term solution.
Or maybe your pattern is to
head straight to the positive,
whatever the situation. Can-do,
will-do. There is courage in this.
But it may mean that you’re
skipping the necessary grieving
process which will help you slowly
integrate this new reality, so that
you can move on with your life.
Nobody says it is easy. But if
the process is difficult, be assured
that you don’t need to go through
it alone.
Living with diabetes
Diabetes UK
Careline
Diabetes UK’s Careline
provides confidential support
and information to all people
affected by diabetes. Call
0845 123 2399, and ask
to speak to Careline. Open
Monday to Friday, 9am–5pm.
Careline accepts TypeTalk
calls and has an interpreting
service. Please check the
cost of calls to 0845 numbers
with your phone provider.
Write to: Diabetes UK
Careline, 10 Parkway, London
NW1 7AA for a response
within 21 days. Email
[email protected]
for a response within
10 working days. Careline
cannot provide individual
medical advice.
2013 Type 2 diabetes
67
Living with diabetes
Telling people
A new
beginning
Telling those close to you about your
diabetes will mean you get more support
After being diagnosed, some people may feel like
hiding it from the world. But telling certain people
can really help you and is also a good way of
getting extra understanding and support
I
t’s perfectly understandable that
you may not be looking forward to
telling people about a newly
diagnosed condition like diabetes
– initially, they will probably know
very little about it and how it may
affect your daily life. However, don’t
let this put you off, most people find
their employers, friends and family
are very understanding once the
news has been shared. Also, they
68
Type 2 diabetes 2013
often find that they get more
support and are better able
to cope with their newly altered
circumstances.
Friends and family
Friends and family can give you
valuable support, especially when
you are newly diagnosed or when
you’re struggling to manage your
diabetes. Telling them can also help
them understand the part they can
play to help diabetes fit into your life.
For example, you may find sharing
aspects such as eating healthily and
keeping physically active, helpful.
They may be able to help you stick
to the correct diet, especially if you
have been advised to lose weight.
Physical activity is also a very
important part of managing your
diabetes (see p62) and friends and
telling people
family can play a key role by
participating in any sports or
exercise that you take up, and of
course it will be beneficial to all
those who take part. It is also
important that your friends and
family realise that they do not need
to treat you any differently, and they
can’t ‘catch’ diabetes from you.
Finally, some medicines could
cause your blood glucose level to
drop too low for you to be able to
function normally. If your friends
and family are aware of what the
symptoms of this are, they can help
you to get the correct treatment and
prevent any misunderstandings.
Healthcare team and
hospital staff
If you have to go to hospital, tell
the staff you have diabetes, don’t
assume they already know.
Although your diabetes won’t
necessarily be affected, it is
sensible to make sure anyone who
is looking after your health knows
about it. This includes dentists,
opticians and podiatrists.
‘Alternative’ practitioners such
as osteopaths, chiropractors,
aromatherapists, and anyone giving
massage or reflexology treatment
will also need to know.
Telling your employer
and colleagues
There’s no legal requirement to
tell your employer that you have
diabetes. But they will probably
want to know what has been
happening to you, especially if
you had time off work.
Accentuate the positive – stress
that diabetes means you must be
aware of time, have a regular routine
and try to follow a healthy lifestyle,
as well as having a thorough
medical each year.
It may not be something
employers openly admit to,
but people with diabetes may
occasionally face discrimination
because of the misconceptions
that some people have about the
condition. The more you know
about diabetes, the more you can
explain it, and why it won’t interfere
with your ability to do your job.
i For more on diabetes and work
see p80.
Telling insurance companies
You must declare that you have
diabetes to any insurance
companies that you hold a
policy with.
Car: You probably won’t be asked
any further questions, but your
insurance could be invalid if you
had an accident and hadn’t told
your insurance company. Also, if
you are treated with insulin, you will
have to tell the Driver and Vehicle
Licensing Agency (DVLA), or in the
case of Northern Ireland the Driver
and Vehicle Agency (DVA) because
of the increased risk of hypos. Your
driving licence will be reissued for a
Living with diabetes
one, two or three yearly term and
you will have to reapply each time
(this is free of charge).
i F
or more on driving and
diabetes see p86.
Travel: Most travel insurance
policies exclude pre-existing
medical conditions (medical
conditions you had before the
policy was taken out) such
as diabetes.
You should always declare it
for your travel insurance to make
sure that you are covered. Some
insurers will not give cover to
people with diabetes or charge
a much higher premium.
i F
or more about travelling
see p82.
Home, mortgage or life
insurance: Once you have
been diagnosed with diabetes
getting this type of insurance
can sometimes be difficult,
so Diabetes UK has produced
a factsheet to help.
i A
free download is available at:
www.diabetes.org.uk/How_we_
help/Financial_services
more you know
“The
about diabetes,
the more you can
explain it properly
”
2013 Type 2 diabetes
69
Living with diabetes
LOVE LIFE
Staying close
Having diabetes should not affect
your desire for or ability to have sex.
However, diabetes can cause problems
which you need to be aware of
Safe sex
It’s important to practise ‘safe’
sex and this includes not only
protecting yourself against
sexually transmitted diseases
(STDs) by using a condom, but
also to prevent an unplanned
pregnancy. All forms of
contraception are suitable for
people with diabetes. See p72
for the different types available.
70
Type 2 diabetes 2013
LOVE LIFE
S
ex is an important part of
relationships for adults of
all ages. An unfulfilling sex life
can lead to feelings of guilt and
rejection, causing problems within a
relationship. Some people who have
diabetes may encounter sexual
problems. But by talking about
the issues with your partner and
consulting a doctor, you’ll be
taking the important steps to
resolving things. Here are some
things to be aware of:
Thrush
This is a common condition that is
made worse by high blood glucose
levels. The best way to limit your
chances of developing it is to control
your diabetes well. If you do develop
it, even though there are creams that
you can buy without a prescription
for treating it, it is better to consult
your diabetes healthcare team about
it, as they will help you to sort out
both problems.
Hypos
Insulin and some other diabetes
treatments can increase the risk of
a hypo if you are very active during
sexual intercourse. Therefore, it is
important that you have some form
of hypo treatment to hand that’s
easy to take if needed. You might
want to tell your partner what to
expect if you have a hypo,
especially if they’re a new partner.
Problems
Around 50 per cent of men with
diabetes and 25 per cent of women
with diabetes will experience some
kind of sexual problems or loss of
sexual desire as a result of their
diabetes. The most common sexual
problems experienced are erectile
dysfunction and female sexual
dysfunction. Not everyone
experiences these problems.
Other possible causes are smoking,
drinking excess alcohol and the use
of some recreational drugs.
Tiredness, stress and poor selfimage can all contribute.
Erectile dysfunction (ED) or
impotence is the medical term for
being unable to get and/or keep an
erection for intercourse. Not only is it
important to talk to your doctor about
this because of your relationship, but
it can indicate other health problems,
such as heart disease.
There are various treatments
available for men with erectile
dysfunction which include tablets,
injection, vacuum therapy and
implants. Men often feel
embarrassment and this leads
them to buy these products via the
internet. Do avoid this, as these
products may be expensive and
they may not contain the correct
amount of medication for you.
Treatment for ED is free on
prescription to men with diabetes,
so talk to your doctor as he/she can
discuss your choices and prescribe
the appropriate treatment for you.
Female sexual dysfunction can
cause dyspareunia (pain with
intercourse), and a loss of desire,
arousal and orgasm. Very little
research has been done into this and
there is very little treatment, although
a vacuum device is available, which
fixes onto the clitoris to encourage
blood flow and lubrication to the
genitalia and vagina.
Living with diabetes
Q& A
What are the physical
causes of sexual
dysfunction?
There are many possible
reasons:
• a hardening of the arteries
(a complication of diabetes)
causes problems with
the blood flow needed
for arousal
• diabetic neuropathy can
damage the nerves involved
with sex
• surgery on the bladder,
bowel, or prostate, can
cause damage to nerves
• some medicines for high
blood pressure and heart
disease, and some
sedatives, tranquillisers and
antidepressants can affect
your desire and arousal,
and possibly lead to
orgasmic dysfunction.
I find it hard to talk to my
partner, what should I do?
Many couples are reluctant to
talk about their problems for
fear of causing each other
more stress. They often feel
embarrassed, frustrated and
guilty and their partners often
feel rejected and angry,
especially if they don’t know
or understand the cause of
the problem. Counselling or
sex therapy may be enough
to resolve any issues.
2013 Type 2 diabetes
71
Living with diabetes
ContracEption
Contraception
options
H
aving diabetes should not
affect your desire for or
ability to have sex, but it is really
important to avoid an unplanned
pregnancy. This is because high
blood glucose levels at the time
of conception can affect the foetus,
causing damage to the developing
heart and blood vessels, and a lack
of folic acid could lead to neural
tube defects, such as spina bifida.
Concerns
Some women are concerned
that having diabetes means they
are unable to take the oral
contraceptive pill. Any form of
contraception that releases either
of the hormones oestrogen or
progesterone carry the risk of
raising blood pressure or causing
a blood clot (thrombosis).
Women with diabetes are
susceptible to the same – but
no higher – risks as any other
woman who uses these forms of
contraception, but if they have any
diabetes complications they should
be advised to avoid hormonereleasing contraceptives. Another
concern is that contraception will
affect diabetes control. Some
women do experience a slight
deterioration in control when they
first start using a form of
contraception that contains
hormones. But this can be easily
monitored and controlled by a slight
change in diabetes medication.
72
Type 2 diabetes 2013
There are lots of
contraception options
available. We take a look at
the pros and cons of each
and their impact on diabetes
Used correctly, most contraception
has more than 90 per cent
effectiveness, but some forms need
more care than others, eg
remembering to take a pill at the
same time every day.
Your GP or a family planning
clinic will help to ensure that the
best choice of contraception is
prescribed for you.
Metformin can sometimes
make women more fertile
so even if you think you are
too old to have children or
are nearing menopause
you may need to
consider contraception.
THE COMBINED PILL
How it works There are several
types, but they all prevent the
ovaries from releasing eggs and
thicken the mucus at the neck of
the womb, which makes it harder
for sperm to enter.
Advantages Can make periods
lighter and less painful.
Disadvantages May cause
weight changes, breast tenderness
and headaches. Women who have
had diabetes for more than 20
years should avoid the combined
pill, as well as those who smoke or
are aged over 35.
Diabetes effects? The hormones
may affect blood glucose levels.
PROGESTOGEN ONLY
PILL (POP)
How it works Thickens the
mucus in the neck of the womb,
making it harder for sperm to
enter the womb. It also thins
the lining of the womb so that
there is less chance of a fertilised
egg implanting.
Advantages Providing there
are no medical problems, such
as heart disease or stroke, it can
be taken until menopause or the
age of 55.
Disadvantages Periods may
be irregular. Side effects at first
can include spotty skin, breast
tenderness, weight change and
headaches. It has to be taken at
the same time every day or it will
not protect against pregnancy.
Diabetes effects? The
hormone may affect blood
glucose levels.
VASECTOMY/TUBAL
LIGATION
How it works A vasectomy
(for men) cuts the tubes that
deliver sperm, and a tubal ligation
(for women) blocks the fallopian
tubes, so a fertilised egg can’t
reach the womb.
Advantages Very reliable.
Disadvantages Involves
surgical procedure.
Diabetes effects? No.
ContracEption
CONDOM
How it works Covers the penis,
preventing sperm from entering
the womb.
Advantages Protects from
sexually transmitted infections.
Only used when you have sex.
Disadvantages Can interrupt
sex. May break. Some people
are sensitive to the chemicals in
latex or spermicide.
Diabetes effects? No.
CAP/DIAPHRAGM
How it works Fits inside the
vagina and covers the cervix,
which prevents sperm from
entering the womb. A
spermicide (a chemical that
kills sperm) is also used.
Advantages Only has to be
used when you have sex.
Disadvantages Can interrupt
sex. Spermicide can be messy.
Can take time to learn how to
use it. Cystitis can be a problem
for some women. Some people
are sensitive to the chemicals in
latex or spermicide. All types of
diaphragm and cap need to be
kept in place for at least six
hours after intercourse and
no longer than 30 hours (latex)
or 48 hours (silicone). High
failure rate if used incorrectly
or they burst.
Diabetes effects? No.
IMPLANTS
How it works A small flexible
rod is placed just under the skin
in the upper arm, which releases
a progestogen hormone that
acts in the same way as the
combined pill.
Advantages Lasts for three
years, so you don’t have to think
about it very often and may
reduce painful, heavy periods.
Disadvantages Requires a small
procedure to have it fitted and
removed. Side effects may
include headaches, breast
tenderness and mood changes.
May also cause weight gain and
increase blood pressure.
Diabetes effects? The hormone
may affect blood glucose levels.
INJECTIONS
How it works The hormone
progestogen is injected into a
muscle, and acts on the womb
lining in the same way as the
combined pill.
Advantages Depending on
which type you are given, it
lasts for eight or 12 weeks.
Disadvantages Fertility may
take a long time to return. If you
have any side effects you have to
put up with them for a long time.
May cause thinning of your
bones and should only be given
to those over the age of 18 after
careful evaluation by a doctor, as
it can affect bone development.
Can cause weight gain.
Diabetes effects? The
hormone may affect blood
glucose levels.
Living with diabetes
INTRAUTERINE DEVICE (IUD)
How it works A small plastic
and copper device that does
not contain any hormone, but
works by stopping sperm
reaching an egg due to the
release of copper. May also
work by stopping a fertilised egg
from implanting in the uterus.
Advantages It’s effective as
soon as it is inserted and lasts
for five years, although it can
be removed sooner.
Disadvantages Can be
painful to insert.
Diabetes effects? No.
INTRAUTERINE SYSTEM (IUS)
How it works A hormonereleasing version of the IUD
(above), which acts on the
womb lining in the same way
as the combined pill.
Advantages It’s effective as
soon as it is inserted and lasts
for five years, although it can
be removed sooner.
Disadvantages Can be painful
to insert.
Diabetes effects? The
hormone may affect blood
glucose levels.
2013 Type 2 diabetes
73
Living with diabetes
pregnancy & labour
Great
expectations
Having children is a big decision for anyone.
If you are a woman who has diabetes,
however, it is a decision that requires much
more thought and careful planning
M
ost women who have Type 2
diabetes have healthy
pregnancies and healthy babies.
But this isn’t to say that it’s an easy
experience – it requires a lot of
work, planning and dedication on
your part. This is because diabetes
can increase risks to both you and
your baby of serious problems.
The information here is intended
to inform, not alarm. It’s important
that you are aware of the difficulties
so that you and your doctors can
discuss them together and work to
prevent them.
You may be diagnosed with
Type 2 diabetes at an age when you
are not thinking about pregnancy or
perhaps your family has grown up.
Being prescribed metformin may
increase your fertility, so if you
74
Type 2 diabetes 2013
haven’t completed your
menopause, remember that
contraception is the key to avoiding
an unplanned pregnancy (see p72).
Risks to you
• P
re-existing retinopathy may get
worse, so it is really important that
you have your retinal screening
done if it has not been done in the
last 12 months.
• Pre-existing nephropathy may
get worse, so your kidney function
should be checked as early as
possible so that you can be
referred for treatment if required.
• Hypoglycaemia: as you try to
manage your blood glucose and
get tight blood glucose control,
you may find that you have more
hypo episodes if you are on meds
Inform your diabetes healthcare
team if you are planning to
become pregnant
that cause them. It is important to
be aware of your warning signs
and always have your treatment
to hand.
•P
re-eclampsia: although all
pregnant women are at risk,
diabetes increases the risk of this
happening. If your blood pressure
is high, you have fluid retention and
protein in your urine, you will be
closely monitored until it is possible
to deliver your baby safely.
• Pre-term labour: although this
may not be as you planned, you
may need to deliver your baby
earlier than expected, either for
your safety or your baby’s. Some
of the reasons may be if you have
pre-eclampsia, your baby having
grown too large or deterioration in
your kidney function.
pregnancy & labour
women with diabetes have healthy
“Most
pregnancies and healthy babies
”
Risks to
your baby
• Not developing normally
and having congenital
abnormalities, particularly
heart abnormalities.
• Having a neural tube
defect, such as
spina bifida.
• Being large for
gestational dates, known
as macrosomia. This can
cause difficulties with a
vaginal birth and lead to
birth injuries.
• Being stillborn or dying
soon after birth.
How to reduce
these risks
Before pregnancy:
• Tell your diabetes team
that you are planning to
become pregnant.
• If you are overweight with
a body mass index (BMI)
over 27 kg/m2 you may
want to try to lose some
weight (see p55).
• Work on getting good
blood glucose control.
This reduces the risk of
your baby having
congenital abnormalities.
If your HbA1c is more
than 86mmol/mol you
should delay becoming
pregnant, ideally it should
be below 43mmol/mol.
Your diabetes healthcare
team can help you
with this.
• Start taking 5mg folic
acid each day until the
end of the 12th week of
your pregnancy, to help
prevent neural tube
defects. This dose
can’t be bought over the
counter, but is prescribed
by your doctor.
• Check the tablets you are
on. Metformin may be
used before and during
pregnancy, so your
diabetes treatment may
need to be changed or
you may be put on to
insulin for the duration
of your pregnancy. If you
are prescribed statins or
certain blood pressure
tablets, such as ACE
inhibitors, you must stop
taking them as they could
damage your developing
baby. Your doctor will
change you to a type that
is safe for your baby.
• Ask to be referred to a
pre-conception clinic
which is usually run by
the diabetes midwife
and the diabetes
specialist nurse.
• Avoid alcohol while trying
to conceive.
Don’t panic if you find you
are pregnant before you
have had a chance to do
all this preparation, make
an appointment to see your
doctor as soon as possible.
Living with diabetes
top
tips
During pregnancy
Just like all pregnant women, with
or without diabetes, it is important
to follow these tips:
1
Alcohol. Alcohol should be
avoided by all women during
pregnancy because of the
health risks to the baby.
2
Stop smoking. The chemicals in
cigarettes are taken in your
bloodstream to your unborn baby. This
reduces the essential nutrients such as
oxygen reaching your baby, causing
your baby’s heart to beat faster and so
work harder. It can also affect your
baby’s growth rate and the
development of your baby’s brain.
3
Eat a healthy, balanced diet.
Discuss your recommended weight
gain with your diabetes team.
‘Eating for two’ is not necessary and
can cause more harm than good.
4
Stay active. If you were inactive
before you became pregnant, don’t
suddenly take up strenuous exercise.
Choose an activity you like and feel
comfortable doing. Remember that
you may need to slow down as your
pregnancy progresses. Physical
activity can also help you to maintain
good blood glucose control.
2013 Type 2 diabetes
75
Living with diabetes
pregnancy & labour
Once you are pregnant
‘Morning sickness’ can cause
problems with your blood
glucose control.
• Try to eat small, regular starchy
snacks, such as soup and
crackers or plain biscuits.
• Try sipping a drink before getting
out of bed in the morning.
• If you don’t feel like eating and
you are treated with insulin, drink
a sugary drink to avoid going
hypo, but always remember not
to stop taking your insulin.
If this doesn’t help, your doctor
may be able to prescribe a safe
medicine to control the vomiting.
If you have repeated vomiting
and/or a large level
of ketones on testing, you
should seek medical advice
as soon as possible to
prevent the ketones from
harming your baby.
You should be offered joint
antenatal and diabetes clinics
where your diabetes and pregnancy
teams can plan and discuss your
pregnancy with you. You should
also be offered an appointment
with a dietitian.
Because good blood glucose
control is so important to your
baby’s good health, if you don’t
already self-monitor, you should be
given a blood glucose meter for
testing and shown how to use it
and what to look out for. You may
need to test up to eight times a day
and so you will need plenty of test
strips. Your diabetes healthcare
76
Type 2 diabetes 2013
team will advise you about when to
test and why, but as a minimum
you should be testing before
breakfast, one hour after each
meal and before you go to bed.
Your personal target should be
agreed between you and your
team, but in general the rule is to
aim for a fasting blood glucose of
between 3.5 and 5.9mmol/l and
less than 7.8mmol/l one hour
after eating.
If your diabetes is being treated
with insulin you should be told
about hypoglycaemia and given
concentrated oral glucose solution
to use if it occurs.
As well as your routine antenatal
appointments, you should have
contact with your diabetes
healthcare team every one to two
weeks during your pregnancy to
discuss your blood glucose levels.
This may be by phone or in person.
During labour
If your labour starts before 37 weeks
you may be given steroids to help
your baby’s lungs to mature.
Steroids can raise your blood
glucose level so you may have to
take extra insulin and monitor your
blood glucose closely.
Throughout your labour and the
birth you should try to monitor your
blood glucose hourly, aiming to
keep it between 4–7mmol/l.
You may be offered an intravenous
infusion (drip) of dextrose and insulin
if you are unable to keep your levels
within your target range.
i You can find more information
in the NICE guidance for
Diabetes in pregnancy at
www.nice.org.uk/CG063
Q& A
Will my baby be affected
by my diabetes after birth?
Your baby should stay with
you unless there is a medical
reason why he or she needs
extra care. All babies’ blood
glucose levels drop after they
are born, so it is important
that you should start to
feed your baby as soon as
possible – certainly within
30 minutes of birth, and then
every two to three hours.
Your baby’s blood glucose
will be tested two to four
hours after birth, (unless there
are signs of hypoglycaemia)
the target being to keep it
above 2mmol/l.
Once I’ve given birth,
will my diabetes treatment
go back to how it was?
Unless you are breastfeeding
(which provides the best
nutrition for your baby, gives
protection against infections
and helps you to bond),
after you’ve delivered
your baby you will be
able to resume your
pre-pregnancy medications.
pregnancy & labour
Living with diabetes
Specific antenatal care for women with diabetes
Appointment
Your heathcare professional should:
First appointment
(joint diabetes and
antenatal clinic)
Give you information, advice and support about your blood glucose levels.
Ask you questions about your health and diabetes.
Discuss your current medications.
Offer an eye examination (retinal screening) and a kidney test if these have not
been done in the last 12 months.
7–9 weeks
Check that you are pregnant and confirm the gestational age of your baby.
Booking appointment
(ideally by 10 weeks)
Offer information, education and advice about how diabetes will affect your
pregnancy, birth and early parenting (such as breastfeeding).
16 weeks
Offer you a repeat eye examination if you were found to have retinopathy at your
first antenatal appointment.
20 weeks
Offer you a test to check the development of your baby’s heart.
28 weeks
Offer you an ultrasound scan to check your baby’s growth.
Offer you a repeat eye examination if you did not have retinopathy at your first
antenatal appointment.
32 weeks
Offer you an ultrasound scan to check your baby’s growth.
36 weeks
Offer you an ultrasound scan to check your baby’s growth.
Give you information about:
• planning the birth, including timing and types of birth, pain relief and
anaesthesia and changes to your insulin during and after birth
• looking after your baby following the birth, including starting breastfeeding
and the effects of breastfeeding on your blood glucose levels
• contraception and your care after the birth.
Arrange for you to see an anaesthetist to prepare for the safe administration,
should it be necessary, during the birth.
38 weeks
Offer to induce your labour or offer a caesarian section if it is the best option for
you. Offer to start regular tests to check your baby’s health if you are waiting for
your labour to start.
Every week from
39 weeks to birth
Offer tests to check your baby’s wellbeing.
2013 Type 2 diabetes
77
Living with diabetes
Illness & Infections
Feeling off
colour?
Falling ill is never fun, and having diabetes
means that you may need to consider a
few more things. So here are a few tips to
help you on your way to a speedy recovery
Y
our diabetes means that you
have to pay close attention to
any illness or infections you pick up
from time to time. Like other forms
of stress on the body, illness can
raise your blood glucose levels.
Some examples that will upset
your diabetes control include:
• colds, bronchitis and flu
• vomiting and diarrhoea
• urinary infections (eg cystitis)
• skin infections (eg boils,
inflamed cuts and skin ulcers).
Milky drinks and soup are a good
way of taking on carbohydrate
78
Type 2 diabetes 2013
Managing at home
However you manage your
diabetes it’s important not to
stop taking your medication.
When you’re ill or have an
infection your blood glucose
levels will rise even if you’re not
eating as much as usual or are
being sick. Try to drink plenty
of unsweetened fluids and to
rest, as exercise will make
things worse.
Your carbohydrate intake
may need to be taken in an easily
digested form. The following
carbohydrate-containing foods may
be useful alternatives to solid food
when you are feeling unwell:
• milky drinks
• soup
• ice-cream
• Complan/Build-Up
• drinking chocolate
• ordinary squash or
fizzy drinks.
If you test your blood glucose levels
then you may need to do this more
regularly while you’re unwell.
When to get medical help
• you are unable to eat or drink
• you have persistent vomiting
or diarrhoea
• you become drowsy or confused.
You must also seek medical advice
if you are treated with insulin and:
• you have a blood glucose higher
than 25mmol/l despite increasing
your insulin.
• you have low glucose levels.
• you are taking metformin and you
are too ill to drink good amounts
of fluid, your medication may
need to be stopped to reduce the
risk of lactic acidosis.
Hyperosmolar
Hyperglycaemic State
Hyperosmolar Hyperglycaemic State
(HHS) occurs in people with Type 2
diabetes, who may be experiencing
very high blood glucose levels
(often over 40mmol/l). It can
develop over a course of weeks
through a combination of illness,
dehydration and an inability to take
normal diabetes medication due
to the effect of illness. Symptoms
can include frequent urination
and great thirst, nausea, dry skin,
disorientation and, in later stages,
drowsiness and a gradual loss
of consciousness.
Illness & Infections
Living with diabetes
top
tips For diabetes
when you’re ill
If you’re unable to drink you
may be at risk of HHS and
you may need to be admitted
to hospital for insulin and
intravenous fluids.
You may also be admitted to
hospital if:
• a heart attack or intestinal
obstruction is suspected
• you are unable to swallow
or keep down fluids
• you have persistent
diarrhoea
• your blood glucose level
remains above 20mmol/l
despite attempts to
get it lower
• there are any clinical
signs of your condition
worsening, eg Kussmaul’s
respiration (deep,
gasping breaths),
severe dehydration,
abdominal pain
• you live alone, have
no support and may
be at risk of slipping
into unconsciousness.
Managing your
diabetes in hospital
The responsibility for
managing your diabetes
should be shared between
you and the hospital staff.
Although they should be able
to provide you with
diabetes medication and
insulin, if possible take
some with you to avoid
delays and take your own
diabetes equipment (pens,
meters etc) because
they won’t be able to
supply this.
Once your condition
has stabilised don’t assume
everyone treating you will
know you have diabetes –
it’s better to be over-cautious
and keep mentioning it.
Good diabetes control is
important to speed your
recovery. Stress and periods
of inactivity might affect your
blood glucose levels, so if
you test it is important to
test more often.
Even if you go to A&E as
an emergency, you may have
to wait to receive treatment.
In this case, don’t eat or
drink anything should you
need surgery. If your diabetes
treatment means you are at
risk of hypos (see p18), as
soon as you arrive, tell a
staff member that you have
diabetes and may need
to eat or drink to avoid
going hypo.
i See ‘Your care explained’,
from p24.
1
2
3
Continue to take your medication
even if you don’t feel like eating.
If you test your blood glucose
levels do so more frequently.
If your blood glucose levels are
consistently over 15mmol/l, contact
your diabetes healthcare team.
4
If you don’t feel like eating, or you
are feeling sick or can’t keep
anything down, replace meals with
snacks and drinks containing
carbohydrate, which will provide
energy. Sip sugary drinks or suck
on glucose tablets.
5
D
rink plenty of unsweetened
fluids.
ACTION
POINTS
• If you are admitted to hospital make
sure that everyone treating you knows
you have diabetes.
• Become familiar with the signs that
indicate you should seek medical
advice, and make sure that a close
friend, family member, or your carer
are also aware of these points.
2013 Type 2 diabetes
79
Living with diabetes
Work & Discrimination
An even
playing field
being honest
“By
and showing how
you cope with your
diabetes, your
employer is fully in
the picture
”
Unfortunately you may
come across some
discrimination at work.
Here is some advice
that should help you
deal with the situation,
should it arise
Your employer should work with you and
make adjustments to your role if required
T
hankfully, blanket bans on the
recruitment of people with
diabetes are almost a thing of the
past. The UK armed forces are
one of the very few employers who
list people with diabetes as being
ineligible to apply. Some jobs,
however, especially those involving
safety-critical work, will have
legitimate health requirements that
may exclude people with particular
medical conditions and on certain
medication, including diabetes.
Disability discrimination is a vast
area, but the Equality Act 2010
makes it unlawful for an employer
to discriminate against people
because of their disability.
Many people with diabetes
would not class themselves as
80
Type 2 diabetes 2013
disabled. Nevertheless, they
can fall within the scope of the
Equality Act 2010 and therefore
benefit from the Act’s protection.
The Equality Act applies to
England, Wales and Scotland and
the Disability Discrimination Act
applies in Northern Ireland.
The Act defines ‘disability’ as
a physical or mental impairment
that has a substantial and longterm adverse effect on a person’s
ability to carry out normal dayto-day activities. It is important to
remember that medical or other
treatment and aids, which relieve
or remove the effect of the
impairment, are ignored when
assessing whether the effect is
substantial and long-term.
The Act offers protection in a
number of different areas, of
which employment is one.
Unfortunately, people with
diabetes do sometimes face
discrimination in the workplace,
so the definition is there to
protect their rights.
The Act states that an employer
must not treat a disabled person
unfavourably and put them at a
disadvantage because of their
disability. This protection
applies to every stage of the
employment process; recruitment,
terms and conditions of
employment, opportunities
for promotion, training or any
other benefit and selection for
redundancy or dismissal.
Work & Discrimination
Reasonable adjustments
The Equality Act states that
employers have to make
reasonable adjustments (changes
to the way they would normally
do things) to prevent someone
being placed at a disadvantage.
Reasonable adjustments can take
many different forms and for many
people, a few minor adjustments
may be all that is required.
Depending on the
circumstances, examples of
reasonable adjustments might
be, altering duties or working hours.
Although there is no legal
requirement to tell your employer
that you have diabetes, if there is
a health section on an application
form you should state that you
have diabetes.
If you are asked how diabetes
might affect your work, be honest.
You may need to ask for time off for
a clinic appointment or, depending
on your treatment, you may need
to take time out to do a blood test.
Keep positive
By being positive, honest and
showing how you cope with your
diabetes, your employer is fully
in the picture. If you then have
problems in managing your
diabetes, your employer should
be more aware and understanding
about the condition.
If you develop diabetes while in
employment, your employer may
offer to change aspects of your job,
for instance by altering your shift
patterns. If you’re no longer able to
Living with diabetes
meet the health requirements
of your job, your employer may
offer you a different job.
If you have any problems with
your employer’s response to your
diagnosis, you can contact the
Diabetes UK Advocacy Service
(see details in Further information
or visit www.diabetes.org.uk/
advocacy). You can also discuss
the matter with your union,
the Equality and Human Rights
Commission (EHRC), or your
local Citizens Advice Bureau
(CAB), see below.
i Equality and Human Rights
Commission (EHRC):
www.equalityhumanrights.com
Citizens Advice Bureau (CAB):
www.citizensadvice.org.uk
Q& A
ACTION
POINTS
• Be honest with your employer if they
don’t know you have diabetes.
• If you feel you can’t cope with your job
in its present format, ask your employer
to make some reasonable adjustments
to your role.
Can I appeal if my current job changes or my
employment is terminated due to my diabetes?
If you find that you’re being moved to another job or
being discharged on medical grounds, you may wish
to appeal against the decision. Check your position
with a union rep, the local Citizens Advice Bureau
(CAB), or the Equality and Human Rights
Commission (EHRC).
Can I appeal if I am turned down for a job
after an interview?
If you’ve been refused a job and you think it’s solely
because of your diabetes, it may be worth appealing
the decision. Again, get advice from your local CAB,
or EHRC. Your diabetes healthcare team should be
able to provide you with a supporting letter and the
Diabetes UK Advocacy Service can give you more
general information and refer you on to other possible
sources of support if the CAB or EHRC can’t help.
2013 Type 2 diabetes
81
Living with diabetes
TRAVEL
Broad horizons
The world is your oyster and diabetes shouldn’t get
in your way. Here are some general points and tips
to help you have the trip of a lifetime
“Planning
your trip well
in advance
will give you
plenty of
time to get
organised
”
H
aving diabetes doesn’t mean
your globe trotting days
are behind you. Whether you’re
planning to take a chance with the
weather and holiday close to home
in the UK, or you’re heading for
more exotic climates, there’s no
reason to shelve your travel plans.
You will find that you have to plan
your trip carefully and add a few
extra items to your checklist.
Before you go
Planning your trip well in advance
will give you plenty of time to
get organised:
• Order plenty of supplies (see
essentials to pack, right) from
your GP. It’s a good idea to take
twice the quantity of medical
supplies you would normally
use for your diabetes. Most
pharmacies want at least
82
Type 2 diabetes 2013
48 hours’ notice to prepare your
prescriptions. If you would like to
take extra supplies, you may need
to allow longer time to arrange this.
• Shop around for travel insurance
(see top tips for insurance, right).
• Apply for a European Health
Insurance Card (EHIC). If you are
travelling to a European Union
member country – it will ensure
that you have easy access to
healthcare in that country.
Visit www.ehic.org.uk, call
0845 605 0707 or fill in a form
at the Post Office.
• Talk to your diabetes healthcare
team about how to manage your
diabetes while you’re away and
while you’re travelling, especially
if you’re crossing time zones.
• If you’re treated with insulin or a
GLP-1 analogue (exenatide or
liraglutide), then you should carry
diabetes ID and ask your
diabetes healthcare team for a
letter explaining you have
diabetes and your treatment.
• Arrange to have any vaccinations
or malaria tablets you may need.
A safe getaway
If you’re flying, here are a few things
to consider:
• Don’t feel like you have to order
the diabetic meal rather than the
standard one, ask for whatever
you prefer.
• Don’t expect to have perfect
control while travelling.
Interruptions to your routine,
sitting for long periods and
unexpected delays can cause
blood glucose levels to be
higher or lower than usual.
• On long-haul flights take some
healthy snacks with you.
Living with diabetes
TRAVEL
• Don’t store your diabetes
supplies in baggage that is going
to be checked-in at the airport
unless you absolutely have to.
If you are taking insulin, the low
temperate in the hold can
damage it and the blood testing
strips. Instead, keep insulin and
equipment in your hand luggage,
and keep the insulin cool by
using an insulated bag (eg Frio)
or Thermos flask.
• If you take insulin, pack it in a
flask or bubble wrap and place
it in the centre of a suitcase.
• If you take medication that could
cause hypos, keep your hypo
treatment close to hand, as well
as your blood testing meter if you
test your blood glucose levels.
While you’re away
It’s tempting on holiday to forget all
about healthy eating, especially if
you are on a cruise or an allinclusive holiday where the food
supply is constant.
• Balance an over-indulgent meal
with some healthy eating to try to
avoid straying too far from good
diabetes management. You
should be able to choose foods
from local menus and still eat a
balanced diet.
• Overseas travel is also an ideal
time to try different foods.
• Try to be as active as possible.
If the weather is good, go for
evening walks or try some beach
sports or activities.
• Don’t forget to take your
medication. Travelling across
different time zones may mean
that you have to adjust the timing
of your medication, do talk to your
diabetes healthcare team about
how to do this whether you are
treated with tablets or injections.
• It is a good idea to take the right
side of your prescription with you
in case you are ill when away
from home. This means that
any doctor treating you knows
exactly what medications you are
currently prescribed and saves
you struggling to remember.
• If you take insulin, keep it cool
either in a fridge, insulated bag
or Thermos Flask. Insulin that is
in a device can be kept at room
temperature (under 25°C) for
no longer than 28 days.
i Diabetes UK Insurance
Services provides travel
insurance. Call 0800 731 7431 or
visit www.diabetes.org.uk/travel
for details.
3
Essentials
to pack
• Your medication. If you
take injections, take your
injecting device.
•If you test your blood
glucose: a finger pricking
device, blood glucose meter
and glucose testing strips.
•if you take medication that
could cause hypos, take a
hypo treatment.
•Travel insurance emergency
contact number.
•European Health Insurance
Card (EHIC), if appropriate.
top
tips
Insurance
1
Buy your insurance at
least two weeks before
your holiday.
2
D
on’t just buy on price
and check the cover is
what you need (read
the small print).
3
C
hoose an insurance
policy that covers illness
(including a stay in
hospital), emergency
travel home and any
expenses caused by
an extended stay.
4
Be honest and declare
all pre-existing medical
conditions, such as your
diabetes. If you don’t,
it could lead to difficulty
if you need to claim.
Many insurers exclude
pre-existing medical
conditions, including
diabetes, or raise the
price when they hear you
have diabetes. You can
get a quote from
Diabetes UK Insurance
Services and use it as
a comparison.
By following these tips and
preparing carefully well in
advance there’s no reason why
you won’t have a fantastic trip!
2013 Type 2 diabetes
83
Living with diabetes
Festivals
Mud, rain
and rock
’n’ roll
Camping in a field and
listening to loud live
music shows no sign of
going out of fashion. So,
if you’re going to brave
the elements, here are
our tips for staying safe
S
leep deprivation, dodgy food
and, of course, mud and rain
– but don’t let that put you off! The
plus points of a weekend away in
the fresh air with friends and great
music will always outweigh a few
negatives. But make sure you have
these points covered so you can
fully enjoy yourself.
Be prepared
• Visit the festival’s website and
download a map. Work out where
the first aid tent is so you can get
help if you feel unwell.
• If you’re treated with insulin, or
non-insulin injections, get a letter
from your doctor to say you have
diabetes and need to carry
needles and syringes as some
venues will need this. The letter
could also say that you need to
take food into the festival as you
have diabetes; some festivals
don’t let you take in food, and it
84
Type 2 diabetes 2013
Get a map of the site and familiarise yourself
with the location of the main facilities
can be very expensive to buy
on site.
• Check you’ve got all your
diabetes supplies and equipment:
– medication and your injection
pen/syringe
– if you test, your blood glucose
monitoring kit
– If you are at risk of hypos,
your hypo treatment
– snacks.
What to take
• Make sure you have ICE (In Case
of Emergency) on your phone
contacts list – put a number of
someone at the festival and
someone at home – paramedics
will look for this if you’re too ill
to tell them who to contact.
• If you are treated with insulin
keep it cool using Frio packs.
They work by being held under
running water so they’re very
useful: www.friouk.com.
General points
• Carry your diabetes medication,
equipment and hypo treatment if
you need it, with you when you
move around the festival. You may
be a long walk from your tent.
• Consider telling your friends
about your diabetes and how you
act when you are hypo so they
can help you if you need it.
• Charge your phone. Think about
solar power via a backpack or a
charger which uses standard
batteries for your phone. Ask
your local phone store, they’ll
be able to help.
• Remember to take your
medication on time. You
may want to put a reminder
on your phone or ask your
friends to remind you.
• Body art is best avoided,
especially if your diabetes is not
well controlled, as you’re at more
risk of skin infections.
Festivals
Living with diabetes
top
tips
Staying safe
1
2
Carry some kind of diabetes ID.
Drink plenty of sugar-free fluids to
keep you well hydrated, and check
your blood glucose regularly.
3
Consider reducing your insulin dose
if you’re doing a lot of activity or if it’s
very hot.
4
Keep plenty of carbohydrate-based
snacks to hand.
5
6
7
M
ake sure you always have
something to treat a hypo with you.
Make sure your phone is charged.
K
eep to the recommended limits for
alcohol, that is two to three units per
day for women, and three to four units
for men. See p50.
8
Keep away from drugs. See p88.
WALKING
RUNNING
CYCLING
SWIMMING
Challenges to suit all ages
and abilities – there really
is something for everyone.
Find out more:
CLICK www.diabetes.org.uk/events
CALL 0845 123 2399
EMAIL [email protected]
A charity registered in England and Wales (215199) and in Scotland (SC039136). © Diabetes UK 2013 0071A
2013 Type 2 diabetes
85
Living with diabetes
DRIVING
The road
ahead
Diabetes doesn’t
stop you from
driving. However
extra care has
to be taken
86
Type 2 diabetes 2013
DRIVING
D
iabetes won’t stop you from
driving, however extra care has
to be taken and certain authorities
need to be informed.
Firstly, tell your insurance
company about your condition –
you don’t want to find any unknown
small print if you come to make
a claim. If you treat your diabetes
with insulin, you must also tell the
Driver and Vehicle Licensing Agency
(DVLA) or Driver and Vehicle Agency
(DVA) if in Northern Ireland about
your diabetes. You’ll be asked to fill
in a medical questionnaire. If your
diabetes is well controlled, with no
complications and you have a good
awareness of hypos, you’ll normally
be issued with a new licence within
eight weeks. The licence will be
valid for one, two or three years and
will need to be renewed. This is so
your fitness to drive is assessed on
a regular basis – but you won’t be
charged anything for the renewal.
Group 2 licences
Since November 2011 you can hold
a licence to drive a ‘Group 2’ vehicle
(HGV and PCV) if your diabetes is
treated with insulin or medications
that could cause hypoglycaemia. But
you have to undergo an independent
medical assessment every year to
assess your fitness to drive and your
diabetes control. You should monitor
your blood glucose regularly and
store results on a memory meter.
Hypos and driving
People who treat their diabetes with
certain tablets or insulin injections
are at risk of hypos (see p18). A
hypo while driving can be fatal, not
only for the driver, but for others as
well. Always have some form of
snack and hypo treatment in the car.
Even a mild hypo, because of its
effects on the brain, can seriously
impair your driving ability. It’s an
offence to drive while hypo.
Living with diabetes
So always check your blood glucose
levels before and during a journey.
If you feel like you are going hypo,
stop driving, remove the keys from
the ignition and leave the driver’s
seat before testing yourself. Either
move to the passenger seat or step
out of your vehicle, if it is safe to do
so. If you are on a motorbike or
moped, you must remove the keys
from the ignition and dismount.
If the test shows you are hypo,
treat it in the usual way and wait for
your blood glucose levels to rise
before continuing. The DVLA
recommends that you wait 45
minutes after the blood glucose
levels have risen to above 4mmol/l.
You shouldn’t test blood glucose
levels or treat a hypo while in or on
the driver’s seat – and you mustn’t
start driving again until you have
dealt with the hypo.
i Visit www.diabetes.org.uk/driving
for more information.
ACTION
POINTS
• Check blood glucose levels before
driving. If below 5mmol/l have
something to eat.
• Don’t delay or miss a meal or snack.
Try not to drive for more than two hours
without stopping to test your blood
glucose and having a snack,
if necessary.
• If you feel like you are going hypo,
stop driving as soon as possible,
remove keys from the ignition, leave
the driving seat and test yourself. You
must not drive until 45 minutes after
your blood glucose levels have risen
to above 4mmol/l.
• Have hypo treatments to hand.
2013 Type 2 diabetes
87
Living with diabetes
smoking & Drugs
positive
changes
Smoking
Nearly one-sixth of people
in the UK smoke, and
people with diabetes are
no exception – the
proportion of smokers
is exactly the same.
Having diabetes means
that you have a higher risk
of damaged blood vessels,
which can lead to certain
conditions including heart
disease, stroke, problems
with the blood supply
to your legs, and kidney
damage. And smoking
greatly increases
these risks.
Studies also show that
smoking increases the risk of
people with diabetes
developing nephropathy
(kidney disease) and
88
Type 2 diabetes 2013
retinopathy (eye disease).
We all know that smoking
is very bad for us but that
doesn’t make it any
easier to give up and
if you’ve already made
lots of lifestyle
changes because of
your diabetes, smoking
may be the one ‘pleasure’
you are determined to
hold on to.
But quitting smoking
is the single most positive
thing you can do to improve
your health and reduce the
risk of major complications
later in life.
For prolonged good
health stopping smoking is
as important as good blood
glucose control, healthy
eating and being active.
Feel the benefit
after quitting smoking
20 minutes: your blood pressure and
pulse rate return to normal.
8 hours: Nicotine and carbon monoxide
levels in blood reduce by half, oxygen
levels return to normal.
24 hours: Carbon monoxide has left
your body and the lungs start to clear
themselves of mucous.
48 hours: There is no nicotine in your
body. Your ability to taste and smell is
greatly improved.
72 hours: Your breathing will become
easier as your bronchial tubes begin to
relax and energy levels increase.
2–12 weeks: Your circulation will
have improved.
3–9 months: Any coughs, wheezing and
breathing problems will improve as your lung
function increases by up to 10 per cent.
5 years: Your risk of heart attack falls to
about half compared to a person who is
still smoking.
10 years: Your risk of lung cancer falls to
half that of a smoker and your risk of heart
attack falls to the same as someone who
has never smoked.
You can only give up if you want to. It’s no
good other people nagging a smoker to stop.
Different people have different needs and you
may prefer to have an individual session each
week with your practice nurse or you may
like to join a support group. There are a
variety of nicotine replacement treatments
available, and these are all free on the NHS.
Call Quit on 0800 002 200 or visit their
website at www.quit.org.uk for support
and practical advice.
smoking & Drugs
Recreational drugs
Diabetes UK doesn’t advocate the
use of recreational drugs but if
you’re using drugs of any kind,
even on a one-off basis, you need
to know about the effect they
can have.
Even if you take drugs in small
doses, they’ll reduce the control
you have over your muscles, lessen
your reaction time and affect your
concentration, so you might forget
to eat or take your diabetes
medication.
There are many different drugs
around, some legal, some illegal.
Remember – no drug is a safe
drug. There are risks associated
with any drug you take, not just
affecting your diabetes. Some
drugs are illegal and there are heavy
penalties for possessing and
supplying them.
Drugs fall mainly into the
following categories:
• downers (or depressants)
• uppers (or stimulants)
• hallucinogenic.
Watch out for people offering you
‘legal highs’. These are substances
used to replicate the effects of
illegal drugs such as cocaine,
ecstasy or amphetamines.
Their chemical structure is slightly
different, meaning they avoid being
classified as illegal under the
Misuse of Drugs Act 1971, but this
doesn’t mean that they are safe or
approved for people to use. It just
means that they’ve not been
declared illegal to use or possess.
Living with diabetes
Some drugs marketed as
legal highs actually contain
some ingredients that are
illegal to possess.
There are many more drugs
around in many forms, so if you
have any questions about drugs
and you don’t want to talk to your
diabetes healthcare team, contact
‘Talk to Frank’ on 0800 776 600
(24 hours a day, 365 days a year).
This is a free, confidential
information service or you
can visit the website at
www.talktofrank.com. Although
they don’t talk about diabetes
specifically, they give full
descriptions of the effects of
each drug, so you can see
the knock-on effect on
your condition.
ACTION
POINTS
• If you can, quit
smoking.
The benefits
of quitting are
immense while
the costs of
smoking are
numerous.
2013 Type 2 diabetes
89
Complications
Cardiovascular Disease
Looking
after your
Heart
People with diabetes have a higher risk of
cardiovascular disease, so it’s important
to look after yourself to reduce this risk
Y
our heart is an organ that
pumps oxygen and many
other substances via your blood
around your body. Blood vessels
carry blood to and from your
heart as well as to all parts of
your body. Damage to the heart
and blood vessels is collectively
known as cardiovasular disease
and people with diabetes have a
higher chance of developing it.
Cardiovascular problems
Your major blood vessels
consist of arteries which carry
blood away from your heart, and
veins which return it. Damage to
these vessels is referred to as
macrovascular disease.
Capillaries are the tiny vessels
where the exchange of oxygen
and carbon dioxide takes place
and when damage occurs to
these vessels it’s referred to
as microvascular disease.
When fatty materials, such
as cholesterol, form deposits on
the walls of the vessels (known
90
Type 2 diabetes 2013
as plaque), furring up the artery
and reducing the space for
blood to flow, this is described
as arteriosclerosis or
atherosclerosis. If the plaque
ruptures the artery walls, blood
cells (called platelets) try to repair
the damage, but this will cause
a clot to form.
Over time, the walls of blood
vessels lose their elasticity.
This can contribute to the
development of high blood
pressure, or hypertension,
which will cause more damage
to the blood vessels.
The force of the blood being
pumped from the heart can make
the clot break away from the
artery wall and travel through
the system until it reaches a
section too narrow to pass
through. If this happens the
narrow section will become
partially or completely blocked.
Blockage of an artery leads to
the part of the body it supplies
being starved of the oxygen and
nutrients it needs. This is the
cause of heart attack or
strokes (affecting the brain).
Narrowing of the blood vessels
can affect other parts of the body,
such as the arms or legs. This is
called peripheral vascular
disease (PVD). PVD may produce
an intermittent pain known as
intermittent claudication (pain
in the calf muscle). If left
untreated, amputation of the
limb may eventually be necessary.
Blood vessels are damaged
by high blood glucose, high blood
pressure, smoking or high levels
of cholesterol. So, it is important
for people with diabetes to
manage these levels by making
lifestyle changes, such as eating
a healthy diet, taking part in
regular activity, reducing weight if
you are overweight and stopping
smoking. See ‘Action points’ for
all the steps you can take to
stay healthy.
i For more on CVD, visit
www.diabetes.org.uk/cvd
Cardiovascular Disease
Complications
ACTION
POINTS
Steps you can take
to help prevent CVD
• If you smoke, ask for
help to stop.
• Eat a healthy, balanced
diet (see p32).
• Be more physically
active. Choose
something you enjoy.
• If you’re overweight, try
to get down to a healthy
weight. Any weight loss
will be of benefit (see p55).
• Take your medication
as prescribed.
• Get your blood glucose
levels, blood pressure
and blood cholesterol
checked at least once a
year and aim to keep to
the target agreed with
your healthcare team
(see p22).
• If you have any chest
Keeping active is an excellent
way to look after your heart
pain, intermittent pain
when walking, impotence
or signs of a stroke, such
as facial or arm weakness
or slurred speech, you
should contact a doctor
as soon as possible.
2013 Type 2 diabetes
91
Complications
Complications retinopathy
looking after
your eyeS
Keeping a close check on your eyes and
getting them examined every year are
some of the best ways of reducing the
damage that retinopathy can cause
T
o see, light must be able to
pass from the front of the
eye through to the retina, being
focused by the lens. The retina is
the light-sensitive layer of cells at
the back of your eye – the ‘seeing’
part of the eye. It converts light into
electrical signals. These signals are
sent to your brain through the optic
nerve and your brain interprets
them to produce the images that
you see. A delicate network of
blood vessels supplies the retina
with blood. When those blood
vessels become blocked, leaky
or grow haphazardly, the retina
becomes damaged and is unable
to work properly. Damage to
the retina is called retinopathy.
There are different types of
retinopathy: background
retinopathy, maculopathy
and proliferative retinopathy.
Background retinopathy This
will not affect your eyesight, but it
needs to be carefully monitored.
The capillaries (small blood vessels)
in the retina become blocked, they
may bulge slightly (microaneurysm)
92
Type 2 diabetes 2013
and may leak blood (haemorrhages)
or fluid (exudates).
Maculopathy describes when
the background retinopathy is at
or around the macula. The macula
is the most used area of the retina.
It provides our central vision and is
essential for clear, detailed vision.
If fluid leaks from the enlarged
blood vessels it can build up and
causes swelling (oedema).
This can lead to some loss of
vision, particularly for reading and
seeing fine details, and everything
may appear blurred, as if you are
looking through a layer of fluid not
quite as clear as water.
Proliferative retinopathy occurs
as background retinopathy develops
and large areas of the retina are
deprived of a proper blood supply.
This stimulates the growth of new
blood vessels to replace the blocked
ones. These growing blood vessels
are very delicate and bleed easily.
The bleeding causes scar tissue,
that starts to shrink and pull on the
retina – leading it to become
detached and possibly causing
vision loss or blindness. Once the
retinopathy has reached this stage
it will be treated with laser therapy.
Beams of bright laser light make tiny
burns to stop the leakage and to stop
the growth of new blood vessels.
Q& A
My vision hasn’t changed,
but my eye specialist
has told me I need laser
treatment. Is this correct?
Retinopathy frequently has
no symptoms until it is well
advanced. Your eye specialist
has probably caught your
retinopathy at an early
stage before you notice
any visual changes.
Will I be able to drive if
I have retinopathy?
You must tell the DVLA (DVA
in Northern Ireland) if you
develop retinopathy. For
more on driving, see p86.
retinopathy
Complications
macula
sclera
cornea
pupil
iris
vitreous/
humour
aqueous
humour
retina
optic
nerve
lens
ACTION
POINTS
Steps you can take to avoid retinopathy
Everyone over the age of 12 with diabetes should
have the retina of their eyes photographed each
year to check for retinopathy, so that treatment can
be given at the right time. This forms part of the
annual review. High blood glucose levels are the
main cause of retinopathy, but high blood fats
and high blood pressure also play a part. So, to
help prevent any eye problems developing:
• Try to keep your blood glucose, blood fats
and blood pressure at your agreed target
(see p22 regarding target ranges). This is
agreed between you and your healthcare team.
• Tell your doctor if you notice any changes
to your vision (don’t wait until your next
screening appointment).
• Take your medication as prescribed.
• If you’re overweight, try to lose excess weight.
• Eat a healthy, balanced diet.
• If you smoke, ask for help to stop.
• Attend your annual eye screening appointment.
2013 Type 2 diabetes
93
Complications
neuropathy
looking
after your
nerves
Keeping a close eye on your blood
glucose levels and having your feet
checked every year are steps you
can take to avoid neuropathy
N
erves carry messages
between the brain and
every part of our bodies,
making it possible to see,
hear, feel and move. Nerves
also carry signals that we’re
not aware of to parts of the body
such as the heart, causing it to
beat, and the lungs, so we can
breathe. Damage to the nerves is
called neuropathy.
Diabetes can cause neuropathy
as a result of high blood glucose
levels damaging the small blood
vessels which supply the nerves.
This prevents essential nutrients
reaching the nerves. The
nerve fibres are then damaged
or disappear. There are three
different types of nerves:
sensory, autonomic and motor.
94
Type 2 diabetes 2013
Sensory neuropathy affects the
nerves that carry messages of
touch, temperature, pain and other
sensations from the skin, bones
and muscles to the brain. It mainly
affects the nerves in the feet and
the legs, but people can also
develop this type of neuropathy
in their arms and hands.
Symptoms can include:
• tingling and numbness
• loss of ability to feel pain
• loss of ability to detect
changes in temperature
• loss of coordination – when you
lose your joint position sense
• burning or shooting pains –
these may be worse at night time.
The main danger of sensory
neuropathy for someone with
diabetes is loss of feeling in the
feet, especially if you don’t realise
that this has happened. This is
dangerous because you may not
notice minor injuries caused by:
• walking around barefoot
• sharp objects in shoes
• friction from badly fitting shoes
•b
urns from radiators or hot
water bottles.
If ignored, minor injuries may
develop into infections or ulcers.
People with diabetes are more likely
to be admitted to hospital with a
foot ulcer than with any other
diabetes complication.
Autonomic neuropathy affects
nerves that carry information to
your organs and glands. They help
neuropathy
Complications
important to have
“It’s
your feet checked at
least once a year
”
Q& A
Can neuropathy be treated?
The symptoms caused by neuropathy
can be treated, such as medication for
nausea and vomiting, or painkillers for
sensory neuropathy, but these symptoms
will be helped more by getting your blood
glucose levels on target.
What do I do if I become impotent?
If you have neuropathy you may pick up
minor injuries by walking around barefoot
to control some functions
without you consciously
directing them, such as
stomach emptying, bowel
control, heart beating, and
sexual organs working.
Damage to these nerves
can result in:
• Gastroparesis – when food
can’t move through the
digestive system efficiently.
Symptoms of this can
include vomiting, bloating,
constipation or diarrhoea.
• Loss of bladder control,
leading to incontinence.
• Irregular heart beats.
• Problems with sweating,
either a reduced ability to
sweat and intolerance
to heat or sweating related
Talk to your doctor. There are a number
of treatments available and if you also get
your blood glucose well controlled your
problem may be resolved quite quickly.
to eating food (gustatory).
• Impotence (inability to get
or keep an erection).
Motor neuropathy affects
the nerves which control
movement. Damage to these
nerves leads to weakness
and wasting of the muscles
that receive messages from
the affected nerves. This can
lead to problems such as
• muscle weakness which
could cause falls or
problems with tasks,
such as fastening buttons
• muscle wasting, where
muscle tissue is lost
due to lack of activity
• muscle twitching
and cramps.
ACTION
POINTS
Steps you can take
to avoid neuropathy
• Keep your blood glucose within
your target range (see p22).
• Have your feet checked at least
once a year.
• Tell your diabetes healthcare team if
you think you’re developing any signs
of neuropathy.
•
If you think you’ve lost sensation in
your feet, protect them from injury
and check them every day. And talk
to your diabetes healthcare team.
2013 Type 2 diabetes
95
Complications
Nephropathy
looking
after your
kidneys
Keeping your blood glucose and
blood pressure levels on target
will help to keep your kidneys
in good working order
T
he kidneys are bean-shaped
organs about the size of a fist,
which sit at the back of your body
at the bottom of your ribcage. Most
people have two kidneys but some
people are born with only one or
have one removed for a variety of
reasons and live perfectly healthy
lives, as long as the remaining
kidney is functioning well.
What the kidneys do
Kidneys are very important as they
perform a number of vital functions.
After the body uses food for
energy and self-repair, the waste
is sent to the blood. The most
common waste products are urea
and creatinine, but there are many
other substances that need to be
eliminated. Using a system of tiny
blood vessels, the kidneys act as
very efficient filters for getting rid of
waste and toxic substances, and
returning vitamins, amino acids,
glucose, hormones and other vital
96
Type 2 diabetes 2013
substances into the bloodstream.
The waste products, along with
extra fluid that the body does
not need, are then converted into
urine and passed out of the body.
In 24 hours, your kidneys filter
around 150 litres of blood and
produce roughly 1.5 litres of urine.
The kidneys secrete a number of
hormones, which are important for
normal functioning of the body.
One hormone is rennin, which
keeps blood pressure normal. If
your blood pressure falls, rennin is
secreted by the kidneys to make
the small blood vessels narrower,
and so increase your blood
pressure. If your kidneys aren’t
functioning correctly, too much
rennin can be produced, which
leads to high blood pressure.
Blood pressure
Kidney failure causes high blood
pressure but also, high blood
pressure can cause kidney failure.
High blood pressure can damage
the blood vessels and if the blood
vessels in the kidneys are damaged
they are unable to remove the
waste and extra fluid from the body.
The extra fluid left in the blood
vessels may then raise the blood
pressure even more, so it is a
dangerous cycle.
Another hormone is called
erythropoietin. This acts on the
bone marrow to increase the
production of red blood cells.
If your kidney function is reduced,
not enough hormone is produced
and the number of red blood cells
being produced will fall, resulting
in anaemia.
kidneys
“The
perform a number
of vital functions
”
Nephropathy
Complications
Q& A
How will I know if
I have a problem?
There are usually no symptoms
at first, but if you notice your
ankles or fingers swelling you
should see your doctor
urgently. Your blood pressure
may rise and a kidney function
blood test would be done to
measure urea, creatinine,
estimated glomerular filtration
rate (eGFR) and electrolytes
(blood salts) . Any abnormal
or high levels of these would
indicate that your kidneys are
not working correctly. There
will be protein present on
urine testing.
Keeping active can help control your blood
pressure which in turn can prevent nephropathy
Calcium
Vitamin D is essential for a number
of bodily functions including the
absorption of calcium by the
intestine, the normal structure of
bones and effective muscle function.
Vitamin D from your diet needs to be
slightly altered by the kidney before it
can act within the body. If your
kidneys are not working properly you
may have low levels of blood calcium
resulting in muscle weakness and a
softening of the bones.
Nephropathy means damage
to or disease of a kidney.
Diabetes can cause damage to
the tiny blood vessels which supply
the kidneys if blood glucose levels
stay too high. The walls of these
blood vessels in the kidneys
become thickened or irregular,
which prevents them from filtering
waste products out of the blood
into the urine properly.
ACTION
POINTS
Steps you can take
to avoid nephropathy
The best ways to prevent
nephropathy developing are:
• Keep your blood glucose
and blood pressure levels
within your target range
(see p22).
•Have your urine tested for
protein and a blood test
to measure kidney function
at least once a year.
•Take your medication
as required.
Is nephropathy treatable?
Prevention is the best way to
avoid kidney damage. Early
treatment includes keeping
your blood glucose and blood
pressure within your target
range, eating a healthy diet,
not smoking, and being
physically active. You may
also be prescribed
medications called ACE
inhibitors. If the kidney
damage progresses dialysis
and transplantation may be
options. In some cases of
kidney transplant, it is done
alongside a pancreas
transplant. Because the
new organ or cells are ‘foreign’
to the body, drugs must be
taken for life to stop the body
rejecting them.
2013 Type 2 diabetes
97
Further information
about Diabetes UK
ABOUT
Diabetes UK
Diabetes UK is the
leading UK charity that
cares for, connects with
and campaigns on behalf
of all people affected by
and at risk of diabetes.
GET in touch
Call us: 0845 123 2399
Email us: [email protected]
Website: www.diabetes.org.uk
need to talk?
Careline: 0
845 123 2399
Monday–Friday,
9am–5pm
ADDRESS:Macleod House,
10 Parkway,
london NW1 7AA
Join us
Become a member, or, if you’re a healthcare practitioner,
a professional member of Diabetes UK. You’ll receive
many benefits, including our magazines and updates
on the latest developments in diabetes treatment,
care and research. Visit www.diabetes.org.uk/join.
98
Type 2 diabetes 2013
Campaign with us
We work hard to make sure every person with diabetes,
whether Type 1 or Type 2, wherever they live in the UK,
gets the best treatment and services. Our Diabetes
Voices help us make a difference by working alongside
us to campaign and influence for change. Sign up at
www.diabetes.org.uk/DiabetesVoices.
CARE
Connect
Campaign
NATIONAL OFFICES
CONTACT DETAILS
Scotland
The Venlaw, 349 Bath Street, Glasgow G2 4AA
Tel 0141 245 6380
Email [email protected]
Northern Ireland
Bridgewood House, Newforge Business Park,
Newforge Lane, Belfast BT9 5NW
Tel 028 9066 6646
Email [email protected]
Cymru
Argyle House, Castlebridge,
Cowbridge Road East, Cardiff CF11 9AB
Tel 029 2066 8276
Email [email protected]
HOW
DIABETES UK
HELPED ME
They put me in
touch with local
support groups and
gave me lots of
practical information.
Ronnie Auguste
Type 2 diabetes
creating
healthier
communities
together
Working in partnership with
Diabetes UK and Tesco are working
together to create healthier communities,
and to help support those affected by
and at risk of diabetes.
Our partnership will change lives – it aims to raise
£10million to:
• help support the 3 million people who have
to live with diabetes and its effects every day
• help hundreds of thousands of people to take
action to reduce their risk of Type 2 diabetes
• invest in ground-breaking research to find
a vaccine for Type 1 diabetes.
For more information
and support:
• Talk to your Tesco Pharmacy.
Find your nearest Tesco Pharmacy
at Tesco.com/storelocator or
call 0800 505 555*
• Visit www.diabetes.org.uk
*calls are free from a BT landline.