Diabetes an overview and reflection. Part 2
Frank Booth, RGN (Retired)
Diabetes, you have heard, can be bad for your health.
Type 1 management options
The fasting diet was one of the first attempts to manage Type 1 diabetes [1].
Today, an individually tailored regimen of diet and insulin therapy helps maintain blood glucose at a functional level, thereby minimising the risk of diabetes-related complications. Insulin therapy is titrated according to individual need. Modes of action and delivery systems vary, and it is not uncommon to use a combination of these. Modes of action include:
- long acting (24 hours)
- short acting (8 hours)
- fast acting, short duration (rapid acting)
Delivery systems include:
- syringe
- pre-loaded dose pen
- pump (continuous, subcutaneous)
- Islet cell transplant
Type 2 management options
The rapid rise in the number of adults developing type 2 diabetes is considered to be due to:
- increasing levels of obesity
- lack of exercise
- increase in unhealthy diets
- an ageing population
Symptoms may only develop over a number of years, and often it is only ‘picked up’ during a routine medical check-up.
As with Type 1 diabetes, the aim of treatment is to maintain functioning blood glucose levels. This can be achieved through lifestyle changes such as eating a healthy diet and taking regular exercise, and/or medication such as Metformin.
Taking it personally
Diabetes, you have heard, can be bad for your health. Trust me that this is true, at least it is in my case. In the year 2000 I felt a little unwell. I made contact with my GP. Problem one was that they couldn’t find my notes, eventually found it had been “archived” assuming that I had left the Practice as it had been 20 years since the last GP consultation - like many nurses I suspect!
Blood and urine samples were positive for glucose, as was my fasting blood sugar. So, off to the hospital for a Glucose Tolerance Test (GTT), the results of which set me on a ‘no sugar, lose weight now’ diet. Sadly I am somewhat “overweight” - have been from childhood so previous attempts at dieting had failed and more weight added.
During the next seven years the illness progressed slowly but without problem; then the complications started - a catastrophic heart attack, heart failure, pacemaker insertion, and now renal failure, jumping straight in at Stage 4. The tablets I took for my Type 2 diabetes have become ineffective and caused renal failure. I am insulin resistant, so take over 300 units per day; and because, as I’ve said before, the books aren’t always right, I know that the received wisdom regarding diet doesn’t work for me – my glucose goes mad. So, I am lucky that my diabetes care team are willing to listen and accept that I don’t fit the mould – they don’t expect me to conform to the ‘norm’, which puts me in control of my life.
So, why am I writing this?
I suppose to ask that you look out for your patients, inasmuch as you encourage healthier lifestyles even when they are resistant. Diabetes isn’t nice, it’s complications are awful, and it’s becoming an epidemic. You, their nurse needs to be both knowledgeable and aware so that you can provide maximum support.
...then the complications started - a catastrophic heart attack, heart failure, pacemaker insertion, and now renal failure, jumping straight in at Stage 4.