Diabetes

Who suffers from diabetes and why is it relevant to me?

As the number of people with diabetes continues to increase and as thousands still walk around undiagnosed it is a big health problem.

To read about Ana and her experiences of diabetes see her journal

What symptoms should I look for ?

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.

If you are in any doubt it is best to check as early treatment will also reduce the chances of developing serious health problems. You can visit your doctor and also Lloyds pharmacy offer free testing, for your nearest store visit http://www.lloydspharmacy.co.uk

Why should I worry about diabetes?

In 2005 they reckoned that approximately 1.4 million people in the UK are known to have diabetes, and there are an estimated one million people in the UK who have diabetes but don't know it. There are two types of diabetes, the most common form is Type 2 diabetes.

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

People at an increased risk of developing Type 2 diabetes include:

People who are overweight
People who have a family history of diabetes
White people aged over 40 and
People from black and minority ethnic groups aged over 25
Increasingly, many more people are being diagnosed at a much younger age.

What are the complications ?

The reason diagnosis is so important is that diabetes can affect other parts of the body. As so many people are undiagnosed for years , other complications can have arisen by the time they are aware they have diabetes. Complications include heart disease, stroke, blindness, kidney failure, and nerve damage .

How do I find our more about living with diabetes?

You should get some support from your doctor but also do your own research. Diabetes UK has a host of information on their site. Details below.

Type 1 diabetes is treated by injections of insulin for the rest of your life but also needs you to eat a healthy diet that contains the right balance of foods.

Type 2 diabetes is treated mainly by diet, with a need to eat a healthy diet that contains the right balance of foods. Sometimes the doctor may feel this is not enough to keep your blood glucose levels normal so you may also need to take tablets.

Books available:

A range of diabetic monitoring strips and meters are available online from many chemists including

For more information Diabetes UK Aims to improve the lives of people with diabetes and to work towards a future without diabetes Diabetes UK 10 Parkway, London NW1 7AA Diabetes UK Careline 0845 120 2960 Diabetes UK Customer Services 020 7424 1010 Textphone 020 7424 1031 Website : www.diabetes.org.uk

Children with diabetes This is an American based site designed to promote understanding of the care and treatment of diabetes, especially in children. The site includes an email support group for UK parents of children with diabetes, accessible via the website. For more information on the UK group contact jackie.jacombs@childrenwithdiabetes.com http://www.childrenwithdiabetes.com

A recent report from Diabetes UK show the failings that need to be addressed in the treatment and care of those with diabetes.

"I have Type 1 diabetes and so does my now teenage son. My experience of treatment and care for adults is that it is a postcode lottery and very inconsistent. The quality of a person’s treatment plan seems to depend largely on when they were diagnosed and the treatment they were put on at that time." (Diabetes Dialogue 2005)

Diabetes is one of the greatest health challenges facing the UK today. Diabetes frameworks in all nations of the UK set the standards of care that people with diabetes should expect from the NHS. Although improvements have been made in many areas, it is clear that a lot of people are still not accessing, or able to access the level of care that they are entitled to. For many a ‘postcode lottery’ of care still exists and there are inequalities in care for specific communities.

This report draws on a range of information to present a picture of diabetes care in the UK today. It provides a voice for people with diabetes, their families, friends and carers through Diabetes Dialogue, and brings that voice together with publicly available statistics and data on diabetes.

Diabetes UK is working to influence and support the improvement of diabetes care in five key, priority areas, through its ‘Action today, health tomorrow’ campaign. These priorities were identified as crucial to providing excellent diabetes services and were chosen with the help of members of Diabetes UK.

Preventing blindness

All people with diabetes will have their eyes fully checked, at least once a year. Why? Because diabetes is a leading cause of blindness and because treatment can prevent blindness in 90 per cent of those at risk, if applied early and adequately.

What is happening now?
• Progress is veiled in conflicting statistics and it is impossible to accurately assess.
• The latest Department of Health figures say 61 per cent of people in England are being screened, GP practices say the figure is 85 percent. PCTs say 68 per cent of them are meeting national standards for screening. 41 per cent of people with diabetes say they were not offered screening or were not screened using a digital camera.
• Greater progress in programme development and co ordination appears to be being made in Wales, where the screening programme is centrally managed and funded.

What needs to be done?

• All eye screening programmes need to be organised and monitored at a regional level with centrally funded quality assurance.
• All programmes need to ensure that all people with diabetes are contacted and offered screening on an annual basis.
• Digital cameras and the supporting staff and software need to be in place to ensure all people can be screened and be confident of accurate results.
• All programmes need to have strong links to specialist eye clinics to ensure effective treatment for those identified with problems.
• Greater participation in a national audit is needed to produce more reliable data on the success of screening programmes.

Services for children and young people

All children with diabetes will be provided with access to local, high quality, specialist care. Why? Because at least 85 per cent of children with diabetes are not reaching recommended blood glucose levels and because that leaves them at risk of serious problems such as heart disease, blindness and stroke in later life

What is happening now?
• Paediatric Diabetes Specialist Nurses (PDSNs) are overstretched with an average of 100 children per nurse in the UK when the recommended patient case load is a maximum of 70 children to each nurse.
• Only a quarter of Primary Care Trusts (PCTs) in England have made improving care for children a priority in their Local Delivery Plans.
• 85 per cent of children with diabetes in England and 90 per cent of children in Scotland aren’t reaching recommended blood glucose levels - this will result in a higher rate of complications in the future
• A lack of psychological support, problems with schools in dealing with diabetes and a lack of access to insulin pumps are also key issues.

What needs to be done?
• More resources need to be invested in paediatric care to address the chronic staff shortages. All children with diabetes need access to integrated specialist healthcare from dietitians and psychologists as well as paediatric specialist diabetes nurses and paediatric diabetologists.
• Children, families and carers must be offered emotional support and education programmes to suit their needs.
• Transition from child to adult care needs improving.

Structured education

All people with diabetes must be provided with the education they need to be able to effectively manage the condition on a day to day basis. Why? Because only just over half of people with diabetes realise it can lead to heart disease and death and because 95 per cent of diabetes care is self care.

What is happening now?
• All people should be offered structured education from January 2006 yet the reality falls short and the target is unlikely to be met. In England, only 56 per cent of PCTs feature structured education in their Local Delivery Plans (LDPs) and a vast amount of comments submitted to Diabetes UK reflect the fact that education isn’t widely available.
• In Wales only half of Local Health Boards are currently providing structured education for those with Type 1 diabetes and for those with Type 2 diabetes it is as low as 30 per cent of boards providing structured education.
• In Northern Ireland three in four Health and Social Services Boards are prioritising structured education in their plans.

What needs to be done?
• A more long term view and a less patronising approach needs to be taken to diabetes. People with the condition take decisions everyday of their lives that will affect their health. They need to be supported in doing this by systematic education programmes.
• Work is needed to support the development of locally developed courses to meet the new criteria.
• Investment is required to develop specific courses that meet the needs of difficult to reach people such as black and minority ethnic groups.

Emotional and psychological support

People with diabetes must have access to psychological and emotional support. Why? Because between 20 and 30 per cent of people with diabetes will experience significant depression which is often associated with poor self care.

What is happening now?
• A recent survey of PCTs shows 50 per cent of centres providing access to a psychologist but very few people with diabetes said they had access.
• In Wales, evidence suggests that Local Health Boards have no psychologists or counsellors available.
• Many people feel that the provision of emotional support was a significant gap in diabetes services, particularly for children, young people and parents.

What needs to be done?
• Doctors and nurses need to pay greater attention to listening to and supporting the emotional and psychological needs of individuals.
• Greater resources need to be invested to increase access to specialist psychological and emotional support for people with diabetes.
• Further research is needed to investigate the types of emotional support people would benefit from.

Early identification and diagnosis

A systematic early identification programme needs to be put in place across the UK . Why? Because the risk of complications can be greatly reduced through early and effective treatment yet there are up to 1 million people in the UK with diabetes who are not yet aware of it.

What is happening now?
• Only 50 per cent of PCTs in England have programmes in place to identify diabetes early.
• Little is known about the content and delivery of these programmes.
• There are still up to a million people with undiagnosed diabetes in the UK.

What needs to be done?
• Local targeted systems for identifying people early need to put in place based on those at increased risk of diabetes.
• Risk reduction programmes and support needs to be established locally to help those at risk of developing Type 2 diabetes to take action.

Frameworks in England, Scotland, Northern Ireland and Wales have led to some real improvements in diabetes services. Better systems and structures are now in place locally to deliver improved care and in many cases the impact is already being felt.

Efforts are being made to provide a greater focus to diabetes care and to keeping people healthy rather than waiting to treat the complications. A key element of this is diabetes inclusion in the outcomes section of the new General Medical Services (GMS) contract for GPs.

As works in progress the frameworks still leave some large gaps. Too many people with diabetes are still not getting the care they need and this is reflected in their health outcomes. The time for excuses is running out. NHS providers who look to blame external factors are missing the point that they are now responsible for ensuring people get the care they need. A failure to do this will have a major long term cost both to individuals and the health service as people suffer eye, kidney, heart and nerve problems as a direct result of poorly controlled diabetes.

It is also very difficult to assess progress in some areas. The GMS data in some areas is tainted by high levels of exclusions. Information is starting to filter out to patients about the quality of their services but is, all too often, unreliable. This can allow systematic failure to go unobserved. Ultimately a regular, independent, full national audit must be conducted to assess progress.

Source Diabetes UK Dec 2005