Keep your diabetes under control


27 October 2013

Diabetes is a lifelong condition where there’s too much glucose in your blood. There are two main types: type 1 where your pancreas doesn’t make any insulin – the hormone produced to control blood sugar – and type 2 where either your body doesn’t produce enough insulin or the insulin it is producing isn’t working properly.

Both are serious conditions and can cause other health problems in later life. These include nerve damage which can result in limb amputation, kidney failure and diabetic retinopathy, an eye condition that can lead to blindness. Persistent high blood glucose levels can also damage the blood vessels and lead to heart and circulatory disease.

But it’s not all bad news. With careful management of blood glucose levels the chances of developing these complications is much reduced.

Other health checks-ups

Iit’s vital that everyone with diabetes receives the 15 Healthcare Essentials, which include the nine annual checks recommended by the National Institute for Health and Care Excellence (NICE), and equivalent bodies in Scotland and Northern Ireland. People should have foot checks and retinal screening at least once a year, so any problems can be identified early enough to be effectively treated.

Treatment for type 1 diabetes

Insulin replacement therapy is the only treatment for type 1 diabetes. This can be given in one of two ways:

  • Injections: Insulin is self-administered via injection into the body just underneath the skin, usually in fatty areas such as the abdomen, buttock or thigh. This is done several times a day depending on the regime used.
  • Insulin pump: Continuous subcutaneous insulin pumps are small devices worn outside the body, which continuously deliver insulin through a very thin tube or needle under the skin. The needle or tube usually needs replacing every 2-3 days.
    Pumps can be less traumatic than injections and can deliver insulin at varying rates throughout the day and extra insulin can be delivered as needed such as at meal times. NICE has set the criteria that people with type 1 diabetes need to meet in order to receive pump therapy but, despite this, availability is patchy around the UK.  According to research in Diabetologia, the Journal of the European Association for the Study of Diabetes, insulin pumps may be more effective at controlling blood sugar than injections.
    “Whether you take insulin injections or have a pump you still need to be monitoring your blood glucose levels very closely several times a day to check how well your diabetes is being managed,” advises Libby.
  • Pancreas transplants: These are available to treat type 1 diabetes but strict criteria must be fulfilled, meaning they are not a common treatment for type 1 diabetes.

Treating type 2 diabetes

Treatment for type 2 diabetes will vary throughout the course of the condition.

  • Diet and lifestyle changes: “For some people making lifestyle changes such as following a healthy balanced diet, keeping physically active and losing weight if necessary may be enough to control their blood sugar glucose levels, at least initially,” explains Libby.
  • Drug treatments: Type 2 diabetes is a progressive condition and you will likely need medication in the future. There are different types of medication – some encourage the body to produce more insulin, some reduce the body’s sensitivity to insulin and some slow down the rate glucose is absorbed for the food you eat.
  • Insulin: If blood glucose can no longer be controlled by drugs and diet/lifestyle, people with type 2 will need insulin treatment (see above).

What to aim for

Diabetes UK’s general guidelines for target blood glucose levels are:

  • Adults with type 1 diabetes should aim for a blood glucose level reading between 4 and 7 before meals rising to 9 after meals.
  • Children with type 1 should aim for blood glucose levels between 4 and 8 before meals and 10 afterwards.
  • Adults with type 2 need to aim for a reading between 4 and 7 before meals rising to 8.5 afterwards.

“However, you may be given a different target by your doctor or nurse depending on your own individual circumstances,” says Libby.

Monitoring methods for type 1 and 2 diabetes

  • Finger prick blood tests: This will give an accurate reading of your blood glucose levels at that moment. With type 1 diabetes you should be given a blood glucose monitor and a prescription for test strips of paper by your doctor. Some people with type 2 diabetes will be advised to do this too. Your doctor or nurse will discuss with you how often you should be treating your blood glucose level.
  • Continuous monitoring devices: This is done by a sensor underneath the skin which takes readings continuously and produces data which can be downloaded onto a computer and analysed or transmitted wirelessly to an insulin pump, so you see exactly how your levels rise and fall during the day and how meals affect them.
    "Unfortunately access to blood glucose testing strips can be patchy – some local commissioning authorities either don’t fund them or limit the number you can have,” says Libby.
  • Urine test strips: These are strips which change colour when held in a stream of urine. Although less accurate than blood glucose testing they may still be appropriate for some people.

For more information on the different types of diabetes and treatments visit our fact sheet section where you’ll find a host of useful information.

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