Diabetes and Me
Type 2 Diabetes Mellitus
What does it mean for me?
What do I need to know?
Being told you have developed Type 2 diabetes can be a shock and a difficult time. However as we learn more about this condition we realise that it no longer has to be a chronic and progressive disease.
Through changes in our diet we can control the diabetes with minimal medication and even in many cases put the diabetes into remission
Type 2 Diabetes is a condition which develops if your body can no longer respond effectively enough to its own insulin to prevent your blood glucose levels from going too high. Patients with Type 2 diabetes have high levels of glucose and insulin in their blood.
Type 2 Diabetes is diagnosed when blood sugar levels reach a critical point. The commonest test we use is called the HbA1c which looks at how sugary your blood has been over the past 3 months. This same test is used to monitor your condition and allow us to feedback to you how you are getting on.
Treatment for Type 2 Diabetes
The treatment options for type 2 diabetes can range from ‘lifestyle changes’ to having medication either in tablet form or as an injection to help control this condition.
The treatment you receive depends on how early the diabetes has been diagnosed (the sooner the better) and how resistant to insulin your body has become. We may prescribe one medication initially and then reduce this or change to a different medication depending on how well your blood sugar levels are responding.
It is important to realise that all these medications however will only reduce your blood sugars. They treat only the symptoms of the disease, not the root cause.
The raised sugar level is a sign that your body has high levels of a hormone called insulin. The insulin hormone makes you store any extra energy as fat especially in your liver and around your abdominal organs. This is called visceral fat and is dangerous to your health. You may notice this fat as the hard to shift weight off your waistline or having the “bread bin belly” as one of our patients has described it.
Every time we eat, our body produces insulin. When our blood insulin levels are high we are unable to burn off our fat stores and lose weight and reduce our levels of fat hiding in our liver (fatty liver).
Different foods produce different levels of insulin. Eating foods rich in proteins and fat produce less of an insulin release then carbohydrates.
Therefore it makes sense that to reduce our insulin levels down to allow us to burn off our fat stores we need to eat foods that produces less insulin release.
This is why our Eat Real Food programme advocates eating a diet which is nutrient dense and minimally processed. This way of eating is naturally lower in carbohydrates and rich in the vitamins and minerals that are needed to meet our body’s nutritional needs
Patients find they lose weight especially that stubborn spare tyre and their blood sugars reduce, They feel better mentally and physically.
We have supported patients to put their diabetes into remission by treating the root cause through what they eat. We are unable to do this with medication.
Please ask your nurse or GP about our Eat Real Food Program and how you can attend our courses. Please do not make any significant dietary changes until you have checked with us if any of your medication needs to be adjusted first.
Monitoring your Health
We encourage patients to have a blood test every three to six months. This measures your HbA1c, to see how your diabetic control is. We will also regularly monitor your kidneys, cholesterol and also your liver levels which show us if your fat stores in the liver are being used up and healthy liver function is returning.
We like to track your blood pressure, weight and your waist circumference. We aim to keep your waist circumference less then 80cm (31.5ins) in women and 90cm (35.4ins) in men. We find that blood pressure often reduces with an Eat Real Food diet and that medication to treat high blood pressure can often be reduced or stopped.
Your HbA1c allows us to alter medication and see how your sugar levels have been over the previous three months.
We look at 3 categories of HbA1c:
- Less then 42 is normal
- 42-47 is pre diabetic
- 48 and above is diabetic.
We are usually aiming to reduce your HbA1c as much as possible and ideally put your diabetes into remission.
However its important to understand that if your return to a diet high in sugar and processed carbohydrates your diabetes will likely return.
Blood Sugar (glucose) Monitoring
We also give patients the choice of having a blood glucose meter which tells you what your sugar reading in the blood is at the moment. Unlike the HbA1c this is purely a snap shot reading. Only a very small drop of blood is needed.
This can be very helpful for patients, especially initially to see the effect that different foods have on their blood glucose levels. We encourage you to check your blood glucose level before a meal and 2 hours afterwards to see what the effect has been. You will see that a meal low in carbohydrates produces only a minimal rise in blood sugar if at all, where as a meal high in carbohydrates such as pasta or pizza will push your blood glucose readings up.
If you would like a meter please ask your nurse or GP. You will also need a sharps bin, testing strips and lancets added to your repeat prescription
Monitoring your health
Having diabetes and raised sugar readings puts pressure on your body. The small blood vessels in your eyes, kidneys and feet can become damaged. The blood vessels to your brain and heart can become blocked which can lead to strokes and heart attacks. High sugar levels also cause damage to the nervous system and can affect the sensation in our hands and feet and also how your bowel functions.
Because diabetes can cause damage to the blood vessels in your eyes you will be called annually to have the back of your eye checked ( retinal screening). This helps to see early changes and treat any abnormalities hopefully sooner to avoid loss of vision.
We will also ask you every year for an early morning sample of urine in a white topped bottle. This is sent to the lab to check that the kidneys are working well and not leaking protein into your urine because the blood vessels have become damaged from the diabetes.
Keeping your feet healthy
An annual foot check will also be done by our health care assistants who will check the nerve supply in your feet and the circulation.
This helps to highlight any early signs of damage. People with diabetes are at increased risk of infection and foot ulcers and if sensation and circulation is reduced you may not be aware of damage to your feet. It is important to check your feet each day and seek early advice if needed.
You may need to see a podiatrist if you are having difficulties.
Prevention is better then cure so keeping blood sugars in normal range will help to prevent damage to nerves and circulation and reduce the risk of nerve damage and ulcers.
Staying well
Smoking increases your risk of Strokes and Heart Attacks. Having Diabetes also increases your risk of these. Stopping smoking will help to reduce your risk, benefit your overall health and save you money.
If you would like help to stop smoking please see www.hlsglos.org
Patients with Diabetes are more at risk of mental health problems such as anxiety and depression. If you are finding you are having problems with your mood please talk to one of our GP’s. If you would like to attend talking therapy sessions either in a group, or on your own please self refer to Lets Talk either by phone – 0800 073 2200 – or online: www.talk2gether.nhs.uk
Keeping active is great for your mental and physical health. This could be simply walking more, jogging, swimming, playing tennis, pilates or yoga.
Aspen Medical Practice has partnered with Gloucester City ParkRun. We meet every Saturday at 9am at the bandstand for a free 5km run, jog or walk around Gloucester park.
It is open to all abilities and children in a buggy or 4+ are encouraged to join in and we welcome well behaved dogs on a lead.
Final Thoughts
- Don’t panic! For many patients Type 2 Diabetes is a reversible condition.
- Be inspired! Check out by our real patient videos in our website www.eatrealfood.uk
- You are not alone! You are well supported by our excellent team of Diabetic Nurses— Lisa, Debbie and Donna who will work in partnership with you to achieve your goals.
- Dr Kuok, Dr Hodges and Dr Wilson run a complex diabetes clinic which you may be asked to attend if you are struggling to get the diabetes under control. We can then look to understand what is happening and make suggestions.
Newly diagnosed Type 2 Diabetes Checklist
The following needs to take place over the next few weeks:
- Meet with your Diabetes nurse to discuss the diagnosis – please book a double appointment.
- Call this number to book for your Diabetic Retinal Screen on 03004 222216
*This is very important as this screening process is very effective at picking up early changes that may require treatment. - After the initial meeting with your Diabetes nurse, book another double appointment to review your diet and to arrange to test your blood sugars at home. It is very important to understand how different foods can affect your blood sugars.
- We encourage all prediabetic and diabetic patients to attend a Structured Education Programme to learn more about taking control of your diabetes. We strongly believe that patients can reverse their diabetes and need support to do this. There is our in-house programme called Eat Real Food OR the external programme called Diabetes & You – www.ghc.nhs.uk/diabetes-education-sessions-referral-form)
Please discuss these options with your Diabetes Nurse. - All diabetics need annual diabetes check that includes a foot check. In addition, you will be required to bring a first morning urine sample to check for early signs of kidney damage at each check. These checks should happen in your birth month.