What is Diabetes?
Diabetes is a condition that occurs when your blood glucose (sugar) is too high. Blood glucose comes from breaking down the food you eat, it is your main cellular energy source and acts as fuel for all the processes needed for life. Insulin, a hormone made by the pancreas, helps glucose get into your cells. If your body cannot make enough Insulin (people with Type 1 diabetes and some with Type 2), or your body cannot use the Insulin effectively (Type 2), your blood glucose will be too high.
Type 2 Diabetes mostly affects people from mid life onwards and is more common than Type 1 Diabetes. If Diabetes is not reversed or managed properly, blood glucose levels remain high and long term serious complications can occur, including:
- Nerve damage (neuropathy)
- Cardiovascular disease
- Kidney damage (diabetic nephropathy) or kidney failure
- Damage to the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness
- Clouding of the normally clear lens of your eye (cataract)
- Feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations, and in some severe cases, amputation
- Erectile dysfunction
- Bone and joint problems
- Teeth and gum infections
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease that causes the insulin-producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce insulin. Without treatment blood glucose levels would rise to dangerously high levels.
Type 1 diabetes used to be called juvenile onset diabetes, however, whilst it is commonly diagnosed in children, the condition can develop at any age so this term is no longer used.
Regular blood glucose monitoring and insulin injection are required to manage Type 1 diabetes as the body has lost the abiilty to produce its own insulin; insulin is injected or can be delivered by means such as by infusion with an insulin pump.
Most patients with Type 1 diabetes are managed by a hospital specialist, whereas Type 2 diabetes is usually managed in GP surgeries. For this reason we are concentrating on Type 2 on this webpage.
If you would like to find out more about Type 1 diabetes there is a wealth of information on the diabetes.co.uk website.
Type 2 Diabetes
Type 2 diabetes is a metabolic disorder that results in the body:
- Being ineffective at using the insulin it has produced (also known as insulin resistance) and/or
- Being unable to produce enough insulin
This leads to high levels of blood glucose which, over time, can damage the organs of the body.
Type 2 diabetes can be treated by a number of different methods, ranging from lifestyle adjustments to tablet medication and injections, through to bariatric (weight loss) surgery for some people.
Lifestyle changes are advised for everyone with Type 2 diabetes; your nurse may recommend medication alongside lifestyle changes if your blood glucose levels can not be brought down by diet and weight loss alone.
Type 2 Risk
The likelihood of developing Type 2 diabetes is strongly influenced by genetics. For example, research shows that:
- If either parent has Type 2 diabetes, the risk of inheritance of Type 2 diabetes is 15%
- If both parents have Type 2 diabetes, the risk of inheritance is 75%
You are also more at risk if you are of South Asian or African-Caribbean descent.
You can't change your genes but there are a number of factors which can increase the risk of developing Type 2 diabetes if you are susceptible.
- Being overweight or obese
- Having a waist size of 31.5 inches or more (women) or more than 37 inches (men)
- Eating an unhealthy diet
- Physical inactivity
Type 2 Prevention and Management
In Selsey we have a lot of patients with Type 2 diabetes (far more than the national average). The rest of this web page is aimed at this group.
We hope that the support and information here will help all of us to work together to put the condition into remission where possible or to manage it in the best way if this is not possible.
Avoiding Type 2 Diabetes
If you have Type 2 diabetes it is likely that more than one cause is involved.
Often, the most overwhelming factor is a family history of Type 2 diabetes. Other factors may be age, pregnancy or another illness. Most of these are beyond our control.
However, there are a variety of risk factors for Type 2 diabetes which we can infuence. Any of these increase the chances of developing the condition, so we need to work together to address them. These risk factors include:
- Living a sedentary lifestyle
- Bad diet
You can find out if you are at risk of developing Type 2 diabetes by using this calculator tool.
Remission of Type 2 Diabetes
Diabetes UK don’t call it diabetes "reversal", because this might sound like it's permanent, and there’s no guarantee that your diabetes has gone forever. But yes, it may be possible to put your type 2 diabetes into remission. This is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. This could be life-changing.
An HbA1c Blood Test is a measurement of the amount of sugar, irreversibly stuck to a part of each red blood cell (the haemoglobin molecule). People with Type 2 diabetes that are able to get their HbA1c below 42 mmol/mol (6%) without taking diabetes medication are said to have put their diabetes into remission.
A low HbA1c level is the “holy grail” of diabetes management because it is related to lower complication rates!
Type 2 diabetes is mainly put into remission by weight loss. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. However, we do know of people who have put their diabetes into remission 25 years after diagnosis.
If you have obesity, your diabetes is more likely to go into remission if you lose a substantial amount of weight – 15kg (or 2 stone 5lbs) – as quickly and safely as possible following diagnosis.
It’s important to know that not everyone who loses this much weight will be able to put their diabetes into remission. But losing 15kg comes with a lot of health benefits, even if you don’t lead to remission. Research shows that getting support to lose just 5% of your body weight can have huge benefits for your health. Losing extra weight can lead to:
- fewer medications
- better blood sugar levels
- a lower risk of complications.
Managing Type 2 Diabetes
The primary aim of treating Type 2 diabetes is to help control blood glucose levels, as well as weight loss or weight management.
It is also important that we monitor and treat other risk factors such as high blood pressure and high cholesterol. In a lot of patients these are treated as actively as the blood sugars.
Type 2 diabetes can be treated by a number of different methods, ranging from lifestyle adjustments to tablet medication and injections, through to bariatric (weight loss) surgery.
Lifestyle changes are advised for everyone with Type 2 diabetes; your nurse will recommend treatment alongside these changes if your blood glucose levels are too high.
If you require medication, the first drug to be tried is usually metformin. The dose will gradually be increased over several weeks to minimize the risk of side effects. If metformin is contraindicated, not tolerated, or not enough to control your blood sugars you may be offered various combinations of other drugs, often in pairs or even three at a time.
Eventually it may become necessary to inject insulin or other hormones, but healthy eating and activity remain important at every stage.
Reversing diabetes through signifciant weight loss, can help prevent you from having to take multiple medication.
Selsey Medical Practice Diabetes Service & Local Services
Patients who have a diagnosis of diabetes are added to our diabetes register.
If you are on the diabetes register you will be invited to make an appointment to have a blood test, weight check, BP check and foot check with a healthcare assistant, once a year, in your birthday month.
You will receive your results through the post and be offered a follow up appointment with one of the practice nurses who specialise in diabetes. This will either be face to face or by telephone. We offer early morning appointments for those who work. Some people will need additional appointments and follow-ups throughout the year. For those who need more help to improve their diabetes we have a community diabetes specialist nurse and a dietician who specialise in diabetes who visit the surgery once a month.
Diabetes UK: For general information about type 1 and type 2 diabetes, Diabetes UK is an excellent place to start https://www.diabetes.org.uk/
Here are some useful links to our local services:
Retinal screening queries: West Sussex Diabetic Eye Screening Programme tel 01903 285222 ext 84780
Podiatry: Download a self-referral form (click this link)
Desmond: This is a one day course designed for those with newly diagnosed type 2 diabetes. During the pandemic it is being run virtually and is also suitable for those who already have diabetes. For further information please contact the DESMOND team here
Diabetes Community Nursing Team: You can access the diabetes community nursing team directly for help and advice about your diabetes (click this link). This can be useful if you have a problem with your diabetes and cannot speak to a member of staff at the surgery.
Patient information for Type 2 Diabetics
The resources below are here to help you to understand your condition and also link you to some self-care and good health advice.
This is an excellent range of leaflets from Trend Diabetes, covering various aspects of diabetes:
Hypos/Insulin safety: Why do I sometimes feel shaky, dizzy and sweaty?
Ketoacidosis: Type 2 diabetes and diabetic ketoacidosis
Kidneys: Diabetes and your kidneys
Diabetes and travel: Diabetes and travel
Mealtime insulin management: Managing mealtime insulin
Footcare: Looking after your feet
Sick day rules for type 2 diabetes: Type 2 diabetes: What to do when you are ill
Sick day rules for type 1 diabetes: Type 1 diabetes: What to do when you are ill
Steroid tablets: Type 2 diabetes and steroid tablets
Pancreatic exocrine insufficiency: Diabetes and pancreatic exocrine insufficiency
The dieticians at St Richards have produced a good range of leaflets to help you to make changes to your diet to help improve your diabetes. Below are some links to some useful leaflets and booklets:
Chichester dietician Food facts website: Food Facts - University Hospitals Sussex
Reducing carbohydrates booklet: Reducing-Carbohydrates
Diabetes and snacks: Diabetes-and-Snacks
Diabetes first steps: Diabetes-First-Steps
Diabetes and alcohol: Food-Fact-Diabetes-and-Alcohol
Healthy portions plate: Healthy-Portions-Plate
High protein high calorie diet (to help you gain weight after an illness): High-Protein-high-calorie-eating-in-Diabetes
Blood Pressure & Cholesterol Information
Some useful information from the British Heart Foundation and some other organisations:
British Heart Foundation: British Heart Foundation - Beat heartbreak forever
Blood pressure: Understanding blood pressure
Understanding risk factors for heart disease: Understanding risk factors
Managing your weight: Managing your weight - cut your risk of heart conditions
Staying active: 9 ways to get more active
HEARTUK: HEART UK - The Cholesterol Charity
Cholesterol lowering diet: Healthy living - HEART UK
Type 2 Diabetes Drug Information
Two common drugs issued to people with Type 2 diabetes are Metformin which helps to reduce sugar levels in your body, and Statins, which reduce Cholestorol (a type of fat) in your blood, and help reduce the risk of heart attack or stroke. You can download an information sheet for each drug below:
Here are the contact details for the most commonly used glucose monitors. Contact them for help and advice about glucose testing, and to replace or fix faulty machines, replace batteries or finger prickers. They are usually very quick and helpful. There are also some sheets to download for recording your results.
Glucorx (Nexus and K2 ketone meter): call 01483 755133, Website: www.glucorx.co.uk
Glucomen Areo call 0800 243667, Email: firstname.lastname@example.org
Accuchek: call 0800 701000, Website: www.accu-chek.co.uk>support
Discovery sheet: Discovery Sheet for Patients
Blood glucose monitoring diary: Blood Sugar Monitoring card
Blood pressure diary: (link to our form)
Prediabetes is when your blood glucose levels are too high, but not high enough to be called diabetes (In Prediabetes, your HbA1c result is in the range 42-47).
People who develop type 2 diabetes usually have prediabetes first. If you have prediabetes, you are at much higher risk of developing type 2 diabetes. You are also at risk of developing other health conditions, including heart disease or stroke.
Below are some resources to provide more information about the condition and support you to make any lifestyle changes to reduce your risk.
Pre-diabetes advice leaflet: Dietary-Advice-for-Pre-Diabetes
Healthier You (diabetes prevention programme): Healthier You
Chichester Wellbeing Website: Chichester district Wellbeing
There are numerous resources online for diets, but because many require big changes to our regular eating behaviours, we often relapse into the same (or even worse) eating habits when we stop them. It might be better to make regular small changes to our eating habits, rewarding ourselves for achieving positive steps rather than feeling bad about "slip-ups".
Eating healthy food does not have to be more expensive than convenience food (and it is very often cheaper), but we might need to learn a few cooking skills or spend a little longer preparing it. This can be rewarding as well, so congratulate yourself each time you spend a few moments making something special and healthy.
Low Carb Diet
Many people with diabetes are following a low-carb diet because of its benefits in terms of improving diabetes control, weight loss and being a diet that is satisfying and easy to stick to.
Low-carb diets are flexible and can be followed by people with different types of diabetes. Click this link to read more about low carb diets from Diabetes UK.
Low Carb Diet
What to eat on a Low Carb Diet
You can eat any of these in moderation, until you feel satisfied; Fish and seafood, Meat, Eggs, Cheese, Vegetables that grow above ground, Natural fats. Lots of healthy, tasty food here! ...and you can get it all in our local high street!
What to avoid on a Low Carb Diet
These foods are all high in sugar or starch (which is quickly turned into sugar when you digest it). Try to avoid; Potatoes, Pasta, Bread, Rice, Chocolate, Cakes, Sweets, Beer, Fruit, Fizzy drinks. No surpises here, but we are "designed" to crave this stuff so we need good strategies to avoid them!
We really do understand that trying to lose weight is not easy. Finding a way to eat fewer calories than you “burn” is important, but it is not always as simple as "calories in versus calories out".
Making changes to our eating behaviour is difficult for all of us. It is important to acknowledge that stress, work, family life, finances, and previous experiences will all play a part in how we live our lives and often produce challenges and barriers to any changes we would like to see.
We can’t expect to rely on willpower alone to make changes. If we can find ways to change our behaviours through introducing and embedding positive habits, we are more likely to be successful. Plan to make a small change to your eating routine and congratulate yourself every time you succeed. Before you know it, you will do it without thinking.
Science continues to discover more about the role of genetics, metabolic health, hormones and nutrition in weight loss. The good news is, that from wherever you start, there will be an area of your life that you can change, which will improve your physical health, mental health, general wellbeing and in some cases reverse the condition you have been diagnosed with!
It's almost impossible to rely on willpower to make changes. The Book, "Tiny Habits" by B J Fogg phD, encourages us to make changes to our behaviour by creating new habits.
You can plan a new habit by identifying:
- An Anchor moment (a thing you regularly do),
- A new Tiny behaviour that you will do each time the anchor happens (this must be super-easy!), and
- A little Celebration you do each time you complete the new behaviour
You could try this yourself - maybe do something positive each time you open the fridge or when you walk in after a day at work? It doesn't just relate to food - you can make all kinds of changes.