Dr. Rowan Hillson MBE, former national Tsar for Diabetes, spoke about diabetes at the December 2014 meeting of The Community Voice, making the following points:
a. Diabetes is a chronic multisystem disorder characterised by a persistently high blood glucose level, due to a malfunction in the pancreas and it is a life changing condition. The incidence of the disease is increasing from 1.3m people in 2003 to 2.7m people in 2013, and the prevalence of the disease is nearly 4 times higher than the prevalence of all cancers combined. Patients affected deserve the highest personalised care, no matter where that is given, by the best trained experts in diabetes, who continually update their knowledge of research and new treatments for the disease.
b. Diabetes is a common and chronic disease and can have many and varied complications, affecting eyes, major organs of the body, skin, bones, muscles and feet, and those with diabetes may need psychological support to help them cope with the distress and disability of this life changing disease.
c. Diabetes UK’s website lists the 15 essentials for diabetes care including eye testing, BP checks, blood tests, and urine testing - which can show up minute traces of diabetes. Foot care tests should be carried out by trained staff on an annual basis, and many of them could be carried out by the GP or Practice Nurse, or during Hospital appointments when attending with other concerns.
d. When a patient is initially diagnosed with Diabetes, structured diabetes guidelines on lifestyle should be given, such as healthy eating, regular exercise, foot care and a no smoking regime advised. An ongoing care plan, tailored to each individual's need, should be drawn up, with the patient's agreement, but some patients may not wish to have this done. However, patients who do not have regular checks risk hidden diabetic tissue damage such as kidney problems, leading to dialysis, to regulate their kidneys, so it is essential that patients, once diagnosed, have regular checks to monitor their condition.
e. Foot care is vital for Diabetes sufferers and they must learn how to look after their feet by keeping them clean and dry, and, every day, by looking for colour changes, skin breaks or even ulcers, and by touching them to check sensation. There are 61,000 people who have diabetes with a foot ulcer at any time and 7-10/10,000 have a major amputation, the risk being 20 times that of a non-diabetic person, although up to 80% could have been avoided with the proper and correct care.
f. There are many types of Diabetes, which can be inherited. Type 1 needs to be treated with insulin by injection. Type 2 can be associated with obesity, and is mainly treated with tablets at first although many people later need injections of insulin or other glucose-lowering medication. Some patients may control the disease with diet alone. Some find it helpful to test their own glucose levels with a finger prick test.
g. Insulin for injection to replace or add to the body's own insulin, was first processed from pigs, but is now processed from a yeast or bacteria. There is much research being carried out. Inhaled insulin has been developed but is not available in UK. Oral preparations are only in the development stage. Insulin must be given by injection; pre-loaded insulin pens and a continuous glucose pump systems are used.
h. Non-insulin glucose-lowering medications work in different ways in the body. Some reduce appetite or reduce or change the absorption of glucose in the body. Others alter the production of insulin in different ways. Some non-insulin glucose-lowering treatment is given as tablets, some by injections.
i. There is a pancreatic islet cell transplant programme in the UK for Type 1 diabetes patients who are having major problems controlling their blood glucose. Pancreas transplants can also be carried out, usually simultaneously with kidney transplants. Both have varying degrees of success. There is also a programme looking at the use of the patient's stem cells, which shows success in tests on mice, and is in the early stage of research.
j. Concerns were raised by the members that patients, particularly those with learning difficulties, are not always given the information about diabetes by their GP practices. They were advised to raise the issue with GPs and to press for more information about testing from the GP or practice nurse. More information can be found on the Diabetes UK website, including the 15 care essentials, or by telephoning the Diabetes UK care line (0345 123 2399), or asking local chemists.
Donald Edwards thanked the speaker on behalf of the members, who responded with applause.