Diabetes Mellitus

Type 1 diabetes, also known as juvenile diabetes or insulin-dependent diabetes, is a chronic autoimmune condition characterised by the immune system attacking and destroying the insulin-producing beta cells in the pancreas. Insulin, a hormone produced by these cells, is crucial for regulating blood sugar levels by facilitating the uptake of glucose into cells for energy. Without insulin, glucose accumulates in the bloodstream, leading to high blood sugar levels and a range of symptoms.

The onset of type 1 diabetes can be abrupt, with symptoms developing rapidly over a short period. Common signs include the 4 Ts:

• excessive thirst (polydipsia)
• frequent going toilet (polyuria)
• thirst
• tiredness

As well as, unintentional weight loss, fatigue, blurry vision, and irritability. These symptoms often prompt individuals to seek medical attention, where a diagnosis is typically confirmed through a combination of medical history, physical examination, and laboratory tests such as fasting blood sugar, random blood sugar, HbA1C, and glycated haemoglobin tests.

The primary treatment for type 1 diabetes is insulin therapy, aimed at replacing the insulin that the body is no longer able to produce. Most individuals with type 1 diabetes require multiple daily injections of insulin or use insulin pumps for continuous delivery. Continuous glucose monitoring (CGM) systems like freesyle libre are also valuable tools for tracking blood sugar levels in real time and adjusting insulin doses accordingly. Additionally, adopting a healthy lifestyle, including a balanced diet, regular exercise, stress management, and monitoring blood sugar levels, is essential for effective diabetes management.

If left untreated or poorly managed, type 1 diabetes can lead to various complications, including hypoglycemia (low blood sugar, hyperglycemia (high blood sugar, diabetic ketoacidosis (DKA), eye problems, kidney disease, nerve damage, cardiovascular disease, foot problems, and skin conditions. Therefore, close monitoring, regular medical check-ups, adherence to treatment recommendations, and ongoing education about diabetes self-care are crucial for maintaining optimal health and minimising the risk of complications in individuals with type 1 diabetes.

Type 2 diabetes is a chronic metabolic disorder characterised by insulin resistance and relative insulin deficiency. Unlike type 1 diabetes, where the immune system attacks and destroys insulin-producing beta cells, type 2 diabetes typically develops due to a combination of genetic predisposition, lifestyle factors, and ageing. In insulin resistance, cells in the body become less responsive to the effects of insulin, resulting in elevated blood sugar levels.

Symptoms of type 2 diabetes may develop gradually and include increased thirst, frequent urination, unexplained weight loss or gain, fatigue, blurred vision, slow wound healing, and recurrent infections. Some individuals may not experience symptoms, and the condition may only be detected during routine medical check-ups or screening tests.

Diagnosis of type 2 diabetes is based on blood tests that measure fasting blood sugar levels, oral glucose tolerance tests, HbA1C tests, and glycated haemoglobin tests. These tests help to assess blood sugar control and determine whether an individual has diabetes or prediabetes.

Treatment for type 2 diabetes often begins with lifestyle modifications, including dietary changes, regular exercise, weight management, and smoking cessation. These lifestyle interventions aim to improve insulin sensitivity, lower blood sugar levels, and reduce the risk of complications. Occasionally, oral medications or injectable therapies may be prescribed to help lower blood sugar levels and improve insulin sensitivity.

If lifestyle changes and medications are insufficient to control blood sugar levels, insulin therapy may be recommended to supplement the body's insulin production. Insulin therapy may be initiated as a single injection or in combination with other medications, depending on individual needs and treatment goals.

Complications of type 2 diabetes can be severe and include:

• cardiovascular disease
• nerve damage (neuropathy)
• kidney damage (nephropathy)
• eye damage (retinopathy)
• foot problems
• skin conditions

Regular medical monitoring, blood sugar management, and preventive measures are essential for reducing the risk of complications and maintaining overall health in individuals with type 2 diabetes.

In summary, type 2 diabetes is a complex metabolic disorder characterised by insulin resistance and relative insulin deficiency. Early detection, lifestyle modifications, and appropriate medical management are crucial for effectively managing blood sugar levels, reducing the risk of complications, and improving the overall quality of life for individuals with type 2 diabetes.

There is no cure for diabetes. The aim is to manage it to the point that it has as little impact on your life and long-term health as possible. In type 2 diabetes, healthy lifestyle changes such as losing weight and regular exercise can improve the condition. You may need to take tablets to help control it, and insulin injections in advanced cases.

If you suffer from type 1 diabetes, you will need to take insulin for life. This is via a small injection into your abdomen that you will learn to administer yourself.

Gestational diabetes is slightly different: for most women, diabetes will resolve once they've given birth. It may come back for future pregnancies.

Other Types of Diabetes

Gestational diabetes is a form of diabetes that develops in some women who are pregnant. Usually, women won’t have any symptoms of it, but it is checked for at antenatal checks. This form of diabetes may disappear after the pregnancy.

There is a group of people who fall into a category called pre-diabetes (also known as borderline diabetes or having impaired fasting glucose.) This is a stage before type 2 diabetes, where your blood sugar levels are higher than normal but not high enough to class as having type 2 diabetes. It is a crucial stage where it is hugely important to make lifestyle changes such as exercising, eating healthily and losing weight if you are overweight. By doing these things, it is possible to avoid developing diabetes altogether.

If you are concerned about symptoms that suggest diabetes, you should speak with your doctor. If you are well, you can book a routine appointment. If you are unwell, or your symptoms are severe, you should arrange an urgent appointment, or call NHS 111 for advice.

What will my doctor do?

The doctor will ask you about your current symptoms, your past medical history, and any relevant family medical history. They will ask you to do a urine sample, they may test your blood sugar level which is just a small prick at the end of your finger and they may also take some blood tests. Blood tests are required to confirm a diagnosis of diabetes, and if this happens, you will be linked in with a specialist hospital team who will manage your diabetes jointly with your GP.