Diabetes Help

With careful management a person with Type 1 Diabetes can lead a healthy and full life. Type 1 Diabetes develops when insulin production slows or stops. Treatment is by means of insulin injections. This is a daunting prospect for newly diagnosed children and their parents. The main objective of the Diabetes UK Support Holidays is to help children to understand their condition and learn how they can live a full and active life.

While on the Diabetes UK support holiday your child will learn more about how to live with diabetes from Diabetes UK volunteers and healthcare professionals who will provide the daily care for your child. The main purpose of this report is to enable you to take a more active role in caring for your child. This report also discusses the long term health problems that can occur as a result of poor management of diabetes and looks at how the NHS is striving to improve diabetes care for children.

Education and Learning Experience

Diabetes Today

There are two main types of diabetes, Type 1 and Type 2. Type 2 diabetes is largely caused by poor lifestyle choices and being overweight. Type 1 diabetes affects otherwise fit and healthy individuals. Its cause is still unknown, however, studies suggest that it could be triggered by a viral infection during childhood. (Banks, 2006, p51). In 2009 NHS Diabetes found that a majority of diabetes in children is Type 1 Diabetes (NHS Diabetes, March 2009).

If poorly managed type 1 diabetes can lead to serious health problems such as ketoacidosis, hypoglycaemia in the short term and heart disease, liver disease and blindness in the long term. It is for this reason that Diabetes UK actively encourages children and their parents to understand safe management of diabetes.

Benefits and Positive Impact of the Diabetes UK Holiday

The holiday provides an opportunity for your child to meet other diabetic children. As well as making friends this can help them to come to terms with diabetes and understand that they are not alone. This can boost self-esteem and your child will become more confident and feel empowered to take an active role in managing their condition and this is beneficial for the whole family.

Diabetes Care for Children – The Healthcare Team

Partnerships and Shared Care

Diabetes care works on a principal of partnerships and shared care. This means that all parties involved are responsible for the care of the child. The child is the centre of the circle of care and should be considered an expert patient.

By learning to recognise the symptoms and learning to self manage their condition as early as possible they will be in a much stronger position to spot the signs of more serious problems. By working with your child you will feel more empowered to ensure that your child remains healthy.

The Diabetes Support Network

Everyone who has diabetes has an extensive support network. At the centre of this network is the patient. Parents play a vital role in managing a child’s diabetes. Other carers include doctors, nurses and dieticians. The Diabetes UK holiday will have representatives of these caring professionals on hand to monitor and advise your child at all times.

Doctors / diabetologists are the most senior medical professional in the team. Doctors analyse test results and by speaking with the other team members chose the course of medical treatment for the patient. They also carry out annual reviews and refer patients onto other specialists when required. Their main role is to ensure that complications are spotted early and action taken to mitigate long term damage.

Diabetes specialist nurses will provide the day to day care for your child as well as providing educational and moral support. They work to ensure that the doctors prescription is carried out and to ensure that the family is managing the condition effectively.

Dieticians are solely concerned with the diet of your child. The main aim of a dietician is to ensure that your child eats a healthy diet that helps to maintain blood sugar levels. With Type 1 diabetes it is vital to ensure that meals are consistent and on time as rapid reductions in glucose can occur if insulin levels remain high.

The National Service Framework (NSF) for Diabetes

The National Service Framework was set up to ensure that there is a consistent and adequate standard of care across the UK for patients with diabetes. It was published in 2001 and set out aims and objectives for improving the quality of care given to children and adults.

There are two standards which affect children. These standards have the specific aim of ensuring that children with diabetes are well supported to ensure that by the time they become adults they have the knowledge and tools to effectively self manage their condition.

Standard 5:

All children and young people with diabetes will receive consistently high-quality care and they, with their families and others involved in their day-to-day care, will be supported to optimise the control of their blood glucose and their physical, psychological, intellectual, educational and social development.

Standard 6:

All young people with diabetes will experience a smooth transition of care from paediatric diabetes services, whether hospital or community-based, either directly or via a young people’s clinic. The transition will be organised in partnership with each individual and at an age appropriate to and agreed with them.

(Department of Health, 2001)

The Department of Health is taking the care of children and young people with diabetes very seriously. A child’s long-term health, social development and education are all dependant on the careful management of the condition. For this reason parents need to understand the issues and play an active role in the care of their children.

Areas that have been improved upon as a result of the NSF include improved education for school staff and teachers and improvements in the way children are transferred from paediatric care to adult care as they pass through adolescence. (Department of Health, 2011)

As children pass through adolescence they will leave pediatric care and move into adult care. Research has shown that this transition can often result in missed appointments and a reduction in care. It is important to be ready to support your child as they pass from pediatric care and into adult care. The more empowered your child is and the more in control of treatment, the more likely that their transition will be smooth (Nakhla, 2009 – quoted in, Daneman, 2011).

Living with Diabetes

Type 1 Diabetes and Physical Development

When diabetes is well managed a child can live an equally active life and participate in sports and athletics and still perform at the highest levels. Steve Redgrave was diagnosed with Type 2 diabetes in 1997 and then went on to win Gold at the Sydney Olympic Games in 2000.

“There is no reason why you still can’t achieve your dreams but it does take a lot of patience to work out the right routine.” Sir Steve Redgrave, Diabetes UK (2011a).

For example, Yusuf Idris plays badminton at a competitive level and to prevent risk of hypoglycaemia he does not take  his lunch time insulin, eats more and also carries snacks to eat at the end of each game (Banks, 2006, Ch 2).

The Importance of Good Diabetes Management

Diabetes can lead to both short term problems and long term complications, however, all complications can be avoided with optimum glucose control.

Short Term Problems of High Glucose Levels

If diabetes is left untreated blood glucose levels will rise. In response to the lack of sugar for the brain, the body starts to breakdown fat tissue to provide fuel which leads to a build up of  acidic ketones. If ketones reach high levels ketocidosis occurs which can cause loss of consciousness, vomiting and dehydration. Also in young children brain swelling and coma can occur which can be fatal.

Good insulin management reduces the risk of developing ketoacidosis occurring. However, It can still occur when diabetes is managed well at times of illness when there is an increase in blood sugar levels (Banks, 2006, Ch 2).

Short-term problems of low glucose levels

A rapid reduction in blood glucose levels can occur if a meal is missed or if a child is more active than normal. While insulin is present in the system it will cause blood sugar levels to fall. If blood sugar levels fall too low then there is a risk of hypoglycaemia which can cause unconsciousness (Banks, 2006, Ch 7). Although usually a person will recover from a temporary loss of consciousness this should never be left to chance. A carer should apply a glucose gel to the gums of the patient who is still conscious or inject glucogon if a patient loses consciousness.

A person with diabetes will often learn to spot the signs of problems before unconsciousness occurs. Symptoms include confusion, aggressiveness, increased sweating, draining of colour from the face. If any if the symptoms occur then the first action is to take a sugary drink and then have something to eat, ideally a sandwich, biscuits or fruit to help raise blood sugar levels.

Long-term problems of high glucose levels

It is the complications that are caused by prolonged periods of elevated glucose that are most well know. Although few children will ever develop signs of long-term damage it is important to understand what can happen if diabetes is not well managed.

High glucose levels causes micro-vascular and macro-vascular damage. This is damage to the small blood vessels and larger veins and a arteries.

Microvascular damage

Microvascular damage affects the nervous system, kidneys and eyes (retinopathy) which makes an annual eye test is important.

A study found that good glucose management “dramatically reduced the risk of developing diabetes complications involving small blood vessels” (Diabetes Control and Complications Trial Research Group, DCCT, 1993).

Macrovascular damage

Macrovascular damage is the biggest cause of death in people with diabetes as it is cause of heart attacks and strokes.

The Importance of a Healthy Lifestyle

It is recommended that children take 60 minutes of exercise every day outside of school (NHS, 2011). Regular exercise helps to maintain a healthy weight as well as regulate blood glucose levels. Exercise also helps to lower blood pressure and reduce LDL (bad cholesterol levels) which can increase long term risk of developing heart disease.

However, it is vital that blood glucose is monitored as exercise can cause it to drop too fast resulting in hypoglycaemia. It is important that people with diabetes wear something to identify them as being diabetic. Bracelets are popular as they can be discrete but easy to find in an emergency (Diabetes UK, 2011b).

You may have to consider making changes to your family routines and diet to accommodate the needs of your child, such as changing cooking methods and increasing family activities.

Considerations for the Future

When your child becomes a teenager their attitudes towards diabetes may change. Studies have shown that teenagers who receive the support of family fare better (Banks, 2006, Ch 10).

Alcohol consumption can affect medication and combined with missed insulin injections alcohol is one of the biggest causes of hypos in young adults. Girls should also be made aware early of the dangers of high glucose during the early stages of pregnancy.

Conclusion

Type 1 Diabetes is an illness that can be successfully managed. With family support and medical assistance a child can live a healthy and full life and need not miss out on any of the pleasures of childhood.

Improvements are constantly being made into the care of children and adults with diabetes and organisations such as Diabetes UK as well as Diabetes specialist nurses, who play an active role in ensuring that patients are aware of changes.

References and Web Resources

Banks, 2006. Living with Diabetes, Milton Keynes, The Open University.

NHS (2011). “How much exercise should my child do?” [online] Available from: http://www.nhs.uk/chq/Pages/819.aspx?CategoryID=52&SubCategoryID=142 (Accessed September 2011)

Department of Health, 2001 “National Service Framework for Diabetes: Delivery Strategy” [online] Available from:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4032823.pdf Published December 2001. (Accessed September 2011)

Department of Health (2011) “Clinical care of children and young people with diabetes”, [online] Available from:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4902159
(Accessed September 2011)

Department of Health (2011)  ”Six years on: delivering the Diabetes National Service Framework” [online] Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_112511.pdf
(Accessed September 2011)

National Institute for Health and Clinical Excellence (2011) “Diabetes in adults quality standard” [online] Available from:
http://www.nice.org.uk/guidance/qualitystandards/diabetesinadults/diabetesinadultsqualitystandard.jsp
(Accessed September 2011)

Royal College of Paediatrics and Child Health (2009)  ”Growing up with Diabetes:  children and young people with diabetes in England” [online] Available from:
http://www.rcpch.ac.uk/sites/default/files/Growing_up_with_Diabetes_Report.pdf

Diabetes UK., (2011a).   ”Sir Steve Redgrave CBE – Diabetes UK supporter”
[online].  Available from:
http://www.diabetes.org.uk/Get_involved/Celebrity-supporters/Steve-/
(Accessed September 2011)

Diabetes UK., (2011b).  ”Living with diabetes”
[online].  Available from:
http://www.diabetes.org.uk/FAQ/Living-with-diabetes-questions/#anchor_4968
(Accessed September 2011)

Diabetes UK., (2011c).   ”Diabetic drivers could be banned by EU rule change”
[online].  Available from:
http://www.diabetes.co.uk/news/2011/Aug/diabetic-drivers-could-be-banned-by-eu-rule-change-99559461.html
(Accessed September 2011)

Nakhla M, Daneman D, To T, Paradis G, Guttmann A (2009): Transition to adult care for youths with diabetes mellitus: findings from a universal health care system. Pediatrics 124:E1134–E1141, 2009.

Denis Daneman, MBBCh, FRCPC and Meranda Nakhla (2011) Moving On: Transition of Teens With Type 1 Diabetes to Adult Care. [online].  Available from:
http://spectrum.diabetesjournals.org/content/24/1/14.full?patientinform-links=yes&legid=diaspect;24/1/14#ref-12

Diabetes Control and Complications Trial Research Group (DCCT) (1993) ‘The effects of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus’, New England Journal of Medicine,  329  (14), pp. 977–986. cited in Banks (2006).

UK Prospective Diabetes Study (UKPDS) (1998) ‘Group Intensive blood
glucose control with sulphonylureas or insulin compared with conventional
treatment and risk of complications in patients with type 2 diabetes (UKPDS
33)’, Lancet, 352, pp. 837–853. cited in Banks (2006).

Many people tend to overlook the fact that skin is the largest organ in the body, and just as you would care for your other organs you should also care for your skin. Proper skin care is important for everyone, this helps keep your skin, not only attractive, but also in a healthy condition and the healthier your skin is the better it can heal should there be any injury.

A very important step in this is proper cleansing and moisturizing of your skin, this is even more important for those who suffer from diabetes. For diabetics skin care is especially important for several reasons; one reason is that because of the circulation issues that many diabetics face,proper skin care is a key to making certain that the skin stays healthy.Although this may seem far fetched keep in mind that when a person cuts or sustains an injury to their skin the scarring can take time to heal. The healing time is even longer for a person with diabetes because the blood circulation in their body isn’t as healthy as someone without diabetes; as a result a diabetic’s skin tends to retain scarring from cuts and injuries to their skin.

There are several precautions that can be taken to help minimize the potential for damage to a diabetic’s skin. One of the best ways to help is to keep the skin moisturized, this means using soap that is friendly to the specific skin type they may have.  After bathing it’s also important to use moisturizing lotions in order to help saturate the skin. The better moisturized skin is the more flexible it is, what this means is that it also has better circulation and better healing capabilities.

Although every care possible should be taken in order to avoid cuts, scratches and damages to a diabetic’s skin, the fact of the matter is that there will be occasions when injuries do happen. Should a diabetic receive a wound to their skin it’s important to treat it properly and take every precaution possible to aid in its healing and to avoid scarring as much as possible.  Just as there are preventative steps when it comes to proper skin care, there are also steps that should be taken if an injury is received. Should a diabetic suffer a skin injury its important to treat it appropriately to help encourage the healing process as well as minimize thescarring. The first thing to do is properly clean the wound to eliminate bacteria and germs. After the cleaning and proper treatment, an antibiotic ointment should be applied and the wound properly bandaged.  Once the wound has closed and begins healing using a lotion that contains vitamin E or cocoa butter which will help in promoting complete healing so that the scarring is kept to a minimum.

Making certain that your skin is healthy is a routine that takes very little time, but reaps big rewards by eliminating issues such as permanent scarring and discolorations from injuries. Aside from the cosmetic aspect of a good skin care routine, for diabetics, the application of skin care products also helps promote healthy circulation, this is why a little bit of effort is well worth the rewards.

Cindi Lewis writes for glossy.com a skin care and beauty products online retailer.

If you do not have diabetes then you should be aware at least of the 4 main risk factors which could result in you developing the disease later in life.

1. Being overweight
2. Lack of Exercise
3. Being Asian or African
4. Family History

Type 2 diabetes is genetic, it is often present in several generation of one family. Type 1 diabetes does not appear to have any genetic causes.

Asians and Africans also have a much higher risk of developing diabetes, especially when they adopt western diets which contain far more processed foods and white bread than their traditional diets consist of.

A lack of exercise seems to also cause increased risk, even in those who are not overweight.

One of the main triggers however is obesity. Being very overweight tends to lead in increased risk.

Singapore Obesity and Diabetes Rates, 1975 - 1995

A classic case study which shows all three factors here in action is in a study of fast food restaurants in Singapore.

Between 1975 and 1995 there was a rapid increase in fast food restaurants in Singapore.

During the same period there was also a rise in cases of type 2 diabetes. See the graph to the left.

Although excess sugar consumption in itself is not necessarily a risk factor, there is a definite correlation between fast food availability and diabetes. The reason seems to mostly be obesity though. It may be possibly to consume a lot of sugar but if you keep your weight down you will be OK. However, the general thought is that a diet high in sugar causes the pancreas to overwork in some cases and eventually start failing.

It is important to know the main risk factors. If you fall into any of these categories and notice some small changes in you energy levels or toilet habits then it may be a good idea to see a doctor. Request a glucose check, it should only take a few minutes for a doctor to take a reading which will indicate whether or not you have a problem.

This is the first of the myths of diabetes which have been plaguing attempts to raise awareness of the disease.

Yes, there are several types of diabetes. Type 1 and Type 2 diabetes are the most common forms, and the only forms which will be discussed in any detail on Diabetes Help. They are both serious diseases which will ultimately be the cause of death for many individuals.

One of the reason why some people feel that a case of diabetes may be mild is because it is the early stages of type 2 diabetes. A person in the early stages of diabetes may not have any outward symptoms at all, they will feel fine, generally be active, alert and healthy.

However, the same processes are still at play inside their body, which is the continued decline in the ability to utilise blood sugar for energy. Most cases of type 2 diabetes will eventually see a person needed insulin injections to survive. Diabates is a degenerative disease which means that the beta cells of the pancreas which release insulin are being slowly destroyed in most cases. Only if you manage to control your diabetes by maintaining a healthy body weight and regular exercise will you avert the eventual decline of the pancreas.

If blood sugar levels are not managed eventually the pancreas will no longer be able to release insulin which will result in rapid weight loss as the body breaks down fats and proteins for energy.

All the time that blood sugar levels are high microvascular and macrovascular damage is also occurring, which means the small blood vessels in the eyes and nervous system and the larger blood vessels of the heart slowly deteriorates.

This damage is irreversible and can occur for years, sometimes for over a decade, before a person is diagnosed with type 2 diabetes. The whole time they feel fine while their body is being destroyed. Once a person starts medication they may just be taking some tablets to control blood sugar levels and also be advised to follow a healthy diet and lifestyle. For this reason they do not feel unwell and will tell people that they just have mild diabetes.

Type 1 diabetes is a different story. Before insulin was discovered in the 1920′s by Dr. Frederick Grant Banting and Dr. Charles Best type 1 diabetes killed within weeks. Type 1 diabetes is when the pancreas completely stops producing insulin. This means that there is nothing to stop the production of glucagon, which is the hormone which breaks down fat and protein for energy.

When fat and muscle is broken down a diabetic will use ketones for energy. As the brain does not need insulin to take up glocose it can still function. However, the glucose derived from the breakdown of TAGs (energy stored in fat cells in the form of glycerols and fatty acids) still causes blood sugar levels to rise as the glucose cannot be removed from the blood by insulin.

However, more serious than this is that the breakdown of ketones raises the acidity of the blood. When the level of acidity rises too much a condition called ketoacidosis occurs, which his essential acid poisoning of the blood. This is fatal. It will cause both vomiting and also excessive urine as the body tries to expel both the acids and the glucose (diabetics tend to urinate more as this is one way for them to release glucose from the blood). Soon dehydration sets in. However, kidney failure and multiple organ failure may occur due to acid poisoning.

Somebody will type 2 diabetes will rarely develop ketoacidosis as even a small amount of insulin will aid the removal of ketones from the blood.

So, the recap, someone with type 2 diabetes may be feeling fine and may be controlling their blood sugars with a course of tablets and improvements to their lifestyle. However, over time more damage is likely to occur which can lead to complications as the disease advances.

With early diagnosis and careful management a person with diabetes can now live a long and active life. But for many it is a great burden, both mentally and physically.