Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The hormone insulin is produced by the pancreas and is responsible for controlling the amount of glucose in the blood.

There are two main types of diabetes:

• Type 1 is where the pancreas doesn't produce any insulin
• Type 2 is where the pancreas doesn't produce enough insulin or the body’s cells don't react to insulin.

Type 2 diabetes is far more common than Type 1. In the UK around 90% of all adults with diabetes have Type 2. There are 3.9 million people living with diabetes in the UK. That's more than one in 16 people in the UK who has diabetes (diagnosed or undiagnosed). By 2025, it is estimated that 5 million people will have diabetes in the UK. Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes, this is sometimes known as prediabetes. It's very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.

There is another type of diabetes called Gestational diabetes which is diabetes in pregnancy. During pregnancy, some women have high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. Pregnancy can also make existing type 1 diabetes worse. Gestational diabetes can increase the risk of health problems developing in an unborn baby.

The main symptoms of diabetes are:

• Feeling very thirsty
• Urinating more frequently than usual, particularly at night
• Feeling very tired
• Weight loss and loss of muscle bulk
• Itching around the penis or vagina, or frequent episodes of thrush
• Cuts or wounds that heal slowly
• Blurred vision

Type 1 diabetes can develop quickly over weeks or even days. Many people have type 2 diabetes for years without realising because the early symptoms tend to be general. It’s important that diabetes is diagnosed as early as possible, so that treatment can be started.

Diabetes can't be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms and to prevent health problems developing later in life. If you're diagnosed with diabetes, you'll be referred to a diabetes care team for specialist treatment and monitoring.

With Type 1 diabetes, as your body can't produce insulin, you'll need regular insulin injections to keep your glucose levels normal. You'll be taught how to do this and how to match the insulin you inject to the food you eat, taking into account your blood glucose level and how much exercise you do. Insulin injections come in several different forms, with each working slightly differently. Some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting). You'll most likely need a combination of different insulin preparations.

With Type 2 diabetes, it usually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but it's not enough in the long term. Eventually the need to take medication to help control your blood glucose levels will occur. Initially, this will usually be in the form of tablets, and can sometimes be a combination of more than one type of tablet. It may also include insulin or other medication that you inject.

There are several different ‘families’ of diabetes medication:

• Biguanide (metformin)
• Sulphonylureas
• Alpha glucosidase
• Prandial glucose regulators
• Thiazolidinediones (pioglitazone)
• DPP-4 inhibitors (gliptins)
• SGLT2 inhibitors.

The long term complications, if the blood glucose level is higher than normal over a long period of time, are gradual damage to the blood vessels. This can occur even if the glucose level is not very high above the normal level. This may lead to some of the following complications:

• Furring or hardening of the arteries, this can cause problems such as angina, heart attacks, stroke and poor circulation
• Kidney damage which can sometimes develop into chronic kidney disease
• Eye problems, the vision can be affected due to damage to the small arteries of the retina at the back of the eye.
• Nerve damage
• Foot problems due to poor circulation and nerve damage
• Impotence due to poor circulation problems and nerve damage.

As well as taking your medicines or insulin, there are a few key steps you can take to prevent or delay the health complications associated with diabetes:

• Lose weight if you are overweight or obese as this will control you blood glucose levels as well as other conditions such as blood pressure and cholesterol
• Eat a healthy and balanced diet that is low in fat, salt and sugar (this does not mean that you can never eat a biscuit) Also read the labels on products as they can be confusing e.g. if it says sugar free on the label it may be substituted with fat
• Don't smoke. Smoking increases the cardiovascular risk of other conditions as well as diabetes.
• Get active for at least 30 minutes daily five times a week. This helps you stay a healthy weight and maintain general good health. Activities may include; gardening, walking and playing with kids as this will increase the heart rate.
• Check your feet regularly as nerve damage can affect the feet
• Keep appointments with your diabetes care team.

There are many local support groups for diabetics and these can be found at your local GP surgery and diabetes clinics. There are also groups online such as Diabetes UK which help other patients deal with diabetes and how it affects them.

If you have any worries or concerns, then please speak to your pharmacist or GP.

References

https://www.diabetes.org.uk/How_we_help/Local_support_groups/

http://www.nhs.uk/Conditions/Diabetes/Pages/Diabetes

http://patient.info/health/type-2-diabetes