Scottish Diabetes Framework

Scottish Diabetes Framework

Scottish Diabetes Framework: Annex B
Understanding Diabetes

Diabetes -- or to give it its full name, diabetes mellitus -- is a common condition in which the amount of glucose (sugar) in the blood is too high because the body is unable to use it properly. This is because the body's method of converting glucose into energy is not working as it should.

Normally, a hormone called insulin carefully controls the amount of glucose in our blood. Insulin is made by a gland called the pancreas, which lies just behind the stomach. It helps the glucose to enter the cells where it is used as fuel by the body.

We obtain glucose from the food that we eat, either from sweet foods or from the digestion of starchy foods such as bread or potatoes. The liver can also make glucose.

After a meal, the blood glucose level rises and insulin is released into the blood. When the blood glucose level falls (for example, during physical activity) the level of insulin falls. Insulin, therefore, plays a vital role in regulating the level of blood glucose and, in particular, in stopping the blood glucose from rising too high.

The two main types of diabetes

Type 1 diabetes (also known as insulin dependent diabetes) develops when there is a severe lack of insulin in the body because most or all of the cells in the pancreas that produce it have been destroyed. This type of diabetes usually appears in people under the age of 40, often in childhood. It is treated by insulin injections and diet.

Type 2 diabetes (also known as non-insulin dependent diabetes) develops when the body can still produce some insulin, though not enough for its needs, or when the insulin that the body produces does not work properly. This type of diabetes usually appears in people over the age of 40. It is treated by diet alone, or by a combination of diet and tablets, or by a combination of diet and insulin injections.

The symptoms of diabetes

The main symptoms of are: increased thirst; going to the loo all the time - especially at night; extreme tiredness; weight loss; genital itching or regular episodes of thrush; blurred vision.

Type 2 diabetes develops slowly and the symptoms are usually less severe. Some people may not notice any symptoms at all and their diabetes is only picked up in a routine medical check up. Some people may put the symptoms down to 'getting older' or 'overwork'.

Type 1 diabetes develops much more quickly, usually over a few weeks, and symptoms are normally very obvious.

In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems.

Who gets diabetes and what causes it?

Although the condition can occur at any age, it is rare in infants and becomes more common as people get older.

Type 1 diabetes develops when the insulin-producing cells in the pancreas have been destroyed. Nobody knows for sure why these cells become damaged but the most likely cause is an abnormal reaction of the body to the cells. This may be triggered by a viral or other infection. This type of diabetes generally affects younger people. Both sexes are affected equally.

Type 2 diabetes used to be called 'maturity onset' diabetes because it usually appears in middle-aged or elderly people, although it does occasionally appear in younger people. The main causes are that the body no longer responds normally to its own insulin, and/or that the body does not produce enough insulin. People who are overweight are particularly likely to develop type 2 diabetes. It tends to run in families and is more common in Asian and African-Caribbean communities. Some people wrongly describe type 2 diabetes as 'mild' diabetes. There is no such thing as mild diabetes. All diabetes should be taken seriously and treated properly.

Other causes of diabetes. There are some other causes of diabetes, including certain diseases of the pancreas, but these are all very rare. Sometimes an accident or an illness may reveal diabetes if it is already there, but they do not cause it.

How is diabetes treated?

Although diabetes cannot be cured, it can be treated very successfully. Knowing why people with diabetes develop high blood glucose levels helps to understand how some of the treatments work.

Blood glucose levels. When sugar and starchy foods have been digested, they turn into glucose. If somebody has diabetes, the glucose in their body is not turned into energy, either because there is not enough insulin in their body, or because the insulin that the body produces is not working properly. This causes the liver to make more glucose than usual but the body still cannot turn the glucose into energy. The body then breaks down its stores of fat and protein to try to release more glucose but still this glucose cannot be turned into energy. This is why people with untreated diabetes often feel tired and lose weight. The unused glucose passes into the urine, which is why people with untreated diabetes pass large amounts of urine and are extremely thirsty.

Type 1 diabetes is treated by injections of insulin and a healthy diet. Type 2 diabetes is treated by a healthy diet or by a combination of a healthy diet and tablets. Sometimes people with type 2 diabetes also have insulin injections, although they are not totally 'dependent' on the insulin.

Treatments for Type 1 diabetes. People with type 1 diabetes need injections of insulin for the rest of their lives and also need to eat a healthy diet that contains the right balance of foods. Insulin cannot be taken by mouth because it is destroyed by the digestive juices in the stomach. People with this type of diabetes commonly take either two or four injections of insulin each day.

Treatments for Type 2 diabetes. People with type 2 diabetes need to eat a healthy diet that contains the right balance of foods. If diet alone is not enough to keep blood glucose levels normal, tablets may also be needed. There are several kinds of tablets for people with type 2 diabetes. Some kinds help the pancreas to produce more insulin. Other kinds help the body to make better use of the insulin that the pancreas does produce. Another type of tablet slows down the speed at which the body absorbs glucose from the intestine.

Reducing the risk of serious health problems

People with diabetes have a higher chance of developing certain serious health problems, including heart disease, stroke, high blood pressure, circulation problems, nerve damage, and damage to the kidneys and eyes. The risk is particularly high for people with diabetes who are also very overweight, who smoke or who are not physically active. The risk of developing any of these complications is greatly reduced by controlling blood glucose and blood pressure levels, and by eating healthily and doing regular physical activity.

Regular medical check-ups. In the last 10 to 20 years, the care for people with diabetes has improved dramatically. One of the most important developments has been improved methods of screening which help healthcare professionals to pick up any health problems at an early stage so they can be treated more successfully. This is why having regular medical check-ups, at least annually, is so important.

Adapted from a Diabetes UK publication. Reproduced with permission.