Diabetes

Diabetes

Did you know…?

There are an estimated
4.5 million people living
in the UK with diabetes.

What Is Diabetes Mellitus?

Diabetes Mellitus, usually known as diabetes is a disease in which the body’s ability to produce and respond to the hormone insulin is affected, and this results in the body’s metabolism of carbohydrates being abnormal and therefore elevates the levels of glucose in the bloodstream.

Key aspects of the body in Diabetes

The hormone insulin is produced in the pancreas.

The pancreas is a large gland that lies behind the stomach, at the back of the tummy area, about the same area as the base of the breastbone. The pancreas is about 15cm (6 inches) long, and is described as looking like a feather under a microscope. The other description of the pancreas is like a tadpole, and described as having a head, body and tail.

The head of the pancreas is next to the duodenum, with the body in the middle of the gland and the tail sitting next to the spleen.

Glucose in the blood is measured in Millimoles per litres of blood, and is abbreviated to mmol/L.

The Different Types of Diabetes

Type 1

Type 1 Diabetes is an autoimmune disease which causes the insulin creating beta cells in the pancreas to be destroyed, this prevents the body from being able to create enough insulin to adequately regulate the glucose levels in the blood.

Type 1 is often referred to as juvenile diabetes, although this term has started to be seen as obsolete, as although it is commonly diagnosed in children, the onset can be diagnosed at any age.

Another term used to describe diabetes is insulin dependent diabetes, because Type 1 Diabetes causes the loss of insulin production, and therefore it requires regular insulin administration either by injection, tablets or insulin pump.

Type 2

Type 2 Diabetes is a metabolic disorder, which results in hyperglycaemia (high blood glucose levels) due to the body becoming insulin resistant and/or being unable to produce enough insulin.

Type 2 Diabetes is usually referred to as non-insulin dependent, as well as, adult-onset diabetes, due to its occurrence in people usually over 40. However this type of diabetes is beginning to become more common in young adults, teens and children.

Did you know…?

In the year 2000,
the first cases of Type 2 Diabetes
were diagnosed in
overweight girls aged 9 to 16 years old.

Type 3

Type 3 Diabetes is a newly found form of diabetes after a study completed in 2012. The term Type 3 is proposed for Alzheimer’s disease which results in resistance of insulin in the brain.

The research pinpoints resistance to insulin and insulin like growth as being a key part of the progression of Alzheimer’s disease.

Gestational Diabetes

Gestational Diabetes occurs during pregnancy. It usually appears in the third trimester which is between 24 and 28 weeks and typically disappears after the baby is born. However, women who develop Gestational Diabetes are more likely to develop Type 2 Diabetes in later life.

Did you know…?

It is estimated
that there are around
1,100,000 in the UK
who have diabetes but
are not diagnosed yet.

Living with Diabetes

Living with diabetes can be very challenging, however diabetic people should be able to lead a normal and full life. Diabetes can affect all aspects of life including:

  • Managing Blood Glucose Levels,
  • Driving,
  • Getting a job,
  • Emotions,
  • Travel,
  • Sexual Relations.
Managing Blood Glucose Levels

Managing blood glucose levels, can be a challenge and can take over a person’s life, especially in the early stages following a diagnosis. Diabetic people will need to monitor their own glucose levels, using the finger prick test, insulin tables or by using an insulin pump.

About 1 in 1,000 people with diabetes wear an insulin pump. The pump is a portable device which is attached to the body that continuously delivers amounts of rapid or short-acting insulin to the body via a catheter placed under the skin. This is seen as a better alternative to traditional methods of getting insulin into the body, namely injection.

Driving

Having diabetes does not result in someone not being able to drive, however, a diabetic person may need to inform the Driver and Vehicle Licensing Authority (DVLA) and their insurance company that they are diabetic.

If the condition is being managed by insulin, the DVLA must be informed, and in addition to this requirement, the DVLA must be informed of any diabetic complications that may affect the ability to drive safely. Should the DVLA and insurance not be informed of the diabetes the insurance may be invalid.

The DVLA do not need to be informed if:

  • Diabetes is being controlled by diet alone,
  • Treatment is by tablets that do not cause hypoglycaemia,
  • Or non-insulin injectable medications are being used.

The DVLA has provided further information as to when someone with diabetes should not drive, however, we feel this is good advice for anyone who drives, as follows:

  • If the diabetic person has difficulty in recognising hypoglycaemia,
  • Has problems with eyesight which are not corrected by wearing glasses,
  • If there is weakness in the arms or limbs,
  • If the driver has been consuming alcohol.

Furthermore, the DVLA also says that if a driver drives for work and is unsure if their diabetes will affect their work, they should contact the DVLA and discuss this in detail with them.

Getting a job

Diabetes on its own should not prevent a diabetic person from getting a job. Anyone with diabetes should declare this at the application stage. There are certain jobs however that being an insulin user, legislation prevents people from applying from as follows:

  • Armed forces,
  • Fire service,
  • Ambulance service,
  • Prison service,
  • Airline pilots and airline cabin crew,
  • Air traffic control,
  • Offshore work.

Although not all roles within these sectors are restricted due to being an insulin user. Some of these roles are also exempt from the Disability Discrimination Act 1995.

Emotions

Anyone living with diabetes can experience negative feelings which are entirely normal, these include:

  • Anger,
  • Frustration,
  • Hopelessness,
  • Fear,
  • Guilt,
  • Shame.

According to the NHS, people with diabetes are more than twice as likely to suffer from depression.

Travel

Although people with diabetes should have no issue in going on their holidays and travels, they do need to prepare and plan for their holidays before they set off, thus ensuring that they have packed enough medication/insulin for their trip.

Using insulin abroad should not usually be a problem. Insulin should never be allowed to freeze, and therefore should be carried in the hand luggage. Also, diabetic people will need to remember that in warmer climes insulin can be absorbed quicker and therefore more careful monitoring of the blood glucose levels needs to take place.

Sexual Relations

Did you know…?

Up to 50% of men
and up to 25% of women
may experience some kind of
sexual problems or a loss of sexual desire
as a result of diabetes.

Diabetic Men

Diabetes can cause damage to the nervous system over a sustained period of time, this can lead to the potential for diabetes to cause damage to erectile tissue, leaving it impossible for a man to achieve or maintain an erection.

Did you know…?

1 in 3 men suffer from erectile dysfunction

Diabetic Women

Some diabetic women will suffer from vaginitis (the inflammation of the vagina), this can make sexual relations painful, and is heralded by itching and burning of the affected area.

Another recurrent problem for a diabetic woman is cystitis.

Like diabetic men, diabetic women can suffer from erectile dysfunction, and therefore the clitoris may not respond to stimulation.

Regardless, of whether you are a diabetic man or woman, there is a concern that a hypoglycaemic emergency may occur during sexual activities. Testing blood glucose levels before and after isn’t exactly going to create the right mood, and therefore isn’t something that the diabetic person would want to do, however it is much better to be honest about diabetes in the first place. If a partner is reassuring and understanding, then maybe a ‘keeper’ has been found.

What are the First Aid concerns of Diabetes?

Did you know…?

1 in 16 people in the UK
have diabetes, whether or not
they are diagnosed.

As a First Aider we are concerned with a diabetic casualty when they are either too high or too low in glucose in their blood. The 2 conditions that a First Aider will deal with are called:

  • Hyperglycaemia
  • Hypoglycaemia.

How do these 2 words translate into English?

Hyper = Over          Hypo = Under

Glyc =  Sugar
Aem(ia) blood

The words hypoglycaemia and hyperglycaemia are latinized from the Greek language. Any word that has got the letters ‘aem’ included together has something to do with the blood.

Hypoglycaemia (Hypo)

Hypoglycaemia is usually caused when a diabetic person:

  • Misses or delays a meal,
  • Has taken too much medication (e.g. insulin or other hypo causing medications),
  • Over-exercises,
  • Drinks excess alcohol.

The main symptoms of hypoglycaemia are:

  • Sweating,
  • Fatigue,
  • Feeling dizzy.

There are other symptoms as follows:

  • Pale,
  • Feeling weak,
  • Feeling hungry,
  • Higher heart rate than usual,
  • Blurred vision,
  • Confusion,
  • Convulsions,
  • Loss of consciousness,
  • Coma (in extreme situations).

A hypoglycaemic event is a First Aid emergency and the First Aider on the scene should try to treat this immediately by providing the casualty with some sugar. Usually as little as 10g of sugar for a child will return the casualty’s blood sugar level to the safe zone, this figure rises to 20g for an adult.

So, what does 10 and 20g of sugar look like?

Glucose Quantity 10g
(Child)
20g
(Adult)
Sugar 2tsp 4tsp
Skittles 10 20
Jelly Babies 2 4
Fizzy Drink
(Not diet)
100ml 200ml
Fruit Juice 100ml 200ml
Lucozade
(Due to 2017 recipe change)
100ml 200ml

If your casualty is starting to look like they are recovering and therefore their glucose levels are returning to the safe zone, you can of course provide them with some additional sugar to fully bring them to the safe zone.

Once they have returned to the safe zone you should, if possible, provide the casualty with a slow releasing carbohydrate, for example a banana sandwich or a bowl of cereal.

NEVER try to provide a casualty with something to eat or drink if they are unconscious or unable to swallow.

Hyperglycaemia (Hyper)

The underlying cause of Hyperglycaemia will usually be from the insulin producing cells in the pancreas or the body having developed a resistance to insulin.

The more immediate concerns are when the diabetic person:

  • Misses a dose of diabetic medication,
  • Contracts an infection,
  • Eats more carbohydrates than the body can cope with,

Is emotionally and/or mentally distressed.

The main symptoms of Hyperglycaemia are:

  • Increased hunger,
  • Increased urination,
  • Increased thirst.

There are other symptoms as follows:

  • Weakness,
  • Lethargy,
  • Blurred vision,
  • Loss of weight.

Hyperglycaemia can be a serious condition if the blood glucose levels stay high for an extended period as well as if the blood sugar levels rise to a dangerously high level which can lead to short term complications, for example ketoacidosis.

Did you know…

If the current trend continues by 2034:
1 in 3 people will be obese
1 in 10 will develop Type 2 Diabetes.

What is ketoacidosis?

Ketoacidosis is most commonly associated with Type 1 Diabetes, but can also be found in Type 2 Diabetes where the body only produces a small amount of its own insulin.

Ketoacidosis is a short-term complication of diabetes; however it can cause a diabetic coma or even death if it is not treated quickly. It is caused when there is insufficient insulin in the body to allow glucose into the cells, therefore the body starts to burn fatty acids, which causes acidic ketone bodies to be produced. A high level of these bodies can cause severe illness.

Symptoms of Ketoacidosis:

On its own, ketoacidosis, can be a symptom of undiagnosed Type 1 Diabetes. The symptoms of ketoacidosis consist of:

  • Vomiting,
  • Dehydration,
  • Fruity smell of the breath (pear drops),
  • Laboured breathing,
  • Rapid heartbeat,
  • Confusion,
  • Disorientation,
  • Coma.

Ketoacidosis usually evolves over a 24-hour period if the blood glucose levels rise and remain too high.

As a First Aider, there is nothing directly that you can do for a casualty who is in a hyperglycaemic state, however, the treatment of a diabetic emergency is the same for First Aiders regardless of whether the casualty is in a hypo or hyperglycaemic emergency. This treatment is to provide the casualty with some sugar, and therefore raising the casualty’s blood glucose levels, this is particularly important in the short term, as it will help the First Aider to identify whether the casualty is hypoglycaemic and therefore, having returned to a more normal state, requires a slow releasing carbohydrate, or whether they are hyperglycaemic and therefore need the First Aider to contact the emergency services.

Did you know…?

The NHS spends approximately
£10,000,000,000, thats
10% of the
NHS budget on treating
diabetes and its complications.

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