Diabetes Care at a Glance E-Book
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- Herausgeber: John Wiley & Sons
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- Serie: Wiley Series on Cognitive Dynamic Systems
- Sprache: Englisch
Diabetes Care at a Glance
The market-leading at a Glance series is popular among healthcare students and newly qualified practitioners for its concise, simple approach and excellent illustrations.
Each bite-sized chapter is covered in a double-page spread with clear, easy-to-follow diagrams, supported by succinct explanatory text.
Covering a wide range of topics, books in the at a Glance series are ideal as introductory texts for teaching, learning and revision, and are useful throughout university and beyond.
Everything you need to know about Diabetes Care … at a Glance!
Diabetes affects a large proportion of the population and it is essential that student nurses, dietitians, podiatrists and other health practitioners and allied healthcare professionals be up to date with the support and treatment that people with diabetes need. Diabetes Care at a Glance contains the latest evidence-based and practical information underpinning diabetes care, illustrating the essential principles of partnership, individualised, and informed care in an easily accessible format.
Edited by an expert in the field, with contributions from academics, practitioners and specialist nurses, Diabetes Care at a Glance covers topics such as:
- Diabetes prevention, diagnosis of type 1 and type 2 diabetes, and consultation approaches and language matters
- Promotion of healthy eating, physical activity promotion, promoting weight loss, and structured education in type 1 and type 2 diabetes
- Prescriptions, emotional and psychological support, person-centred goal setting and assessing risk, and partnership working and adjustment
- Anti-diabetes oral hypoglycaemics and GLP-1s, insulin options, administration and injection technique, pumps, and self-blood glucose monitoring
Written for student nurses, allied healthcare professionals and newly qualified practitioners, Diabetes Care at a Glance is a highly valuable quick reference text, ideal for those looking for an introduction to the topic of diabetes, revision, or for those in need of a refresher.
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Seitenzahl: 234
Veröffentlichungsjahr: 2023
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Table of Contents
Cover
Title Page
Copyright Page
Dedication Page
Contributors
Acknowledgments
Part 1: Introduction
1 Diabetes prevention
References
2 Diagnosis of type 1 diabetes
Diagnosing type 1 diabetes
Honeymoon period
Skills for self‐managing type 1 diabetes
References
3 Diagnosis of type 2 diabetes
References
4 Consultation approaches and language matters
References
Part 2: Principles of diabetes care
5 Promotion of healthy eating
The yellow section
The green section
The blue section
The pink section
The purple section
Salt
Portion sizes
6 Physical activity promotion
References
7 Promoting weight loss
References
8 Structured education in type 1 diabetes
Core education topics
References
9 Structured education in type 2 diabetes
References
10 Information prescriptions
References
11 Emotional and psychological support
References
12 Person‐centred goal setting and assessing risk
References
13 Partnership working and adjustment to living with diabetes
References
Part 3: Pharmacological treatments
14 Oral antidiabetic medications
Sulfonylureas
Metformin
Sodium/glucose cotransporter‐2 inhibitors
Thiazolidinediones
Glucagon‐like peptide 1 analogues
Dipeptidyl peptidase 4 inhibitors
References
15 Insulin options
Rapid‐acting insulin
Short‐acting insulin
Long‐acting insulin
Intermediate‐acting insulins
Premixed insulin
References
16 Insulin administration and injection technique
Insulin injection technique
Lipohypertrophy or lumps at the injection site
Site rotation
Insulin storage
Reference
17 Insulin pump therapy
Troubleshooting high glucose readings
Self‐management guidance
Reference
18 Self blood glucose monitoring
What is self blood glucose monitoring?
Benefits of blood glucose monitoring
Who needs to monitor their blood glucose levels?
Factors that influence BG levels
When to monitor blood glucose
When is BG monitoring unreliable?
How to self‐monitor blood glucose
The process of CBG monitoring (Figure 18.1) (Diabetes UK 2017)
Advances in BG monitoring
Reference
19 Continuous and flash glucose monitoring
20 Interpreting glucose data
HbA1c
Blood glucose records
Continuous glucose monitoring reports
21 Blood pressure and lipid management
References
Part 4: Acute complications
22 Recognizing and treating hypoglycaemia
23 Sick day advice
How illness affects management of diabetes
Acute complications
What people need to know when managing their diabetes during illness
Summary
References
24 Diabetes‐related ketoacidosis
Who can develop it?
How is DKA diagnosed?
Signs and symptoms of DKA
What are the triggers that can lead to DKA?
How is DKA treated?
How to avoid DKA
Hyperosmolar hyperglycaemic state
References
25 Diabetes and steroids
What are steroids?
Different steroids
Steroid‐induced hyperglycaemia or steroid‐induced diabetes
References
Part 5: Life stages
26 Transition
References
27 Preconception care and diabetes
Reference
28 Gestational diabetes
Reference
Part 6: Complications
29 Annual reviews in diabetes care
References
30 Neurovascular foot assessment
Vascular assessment
Peripheral neuropathy
References
Further reading
31 ACT NOW: A foot assessment tool
References
32 Types of ulcers and their presentations
References
33 Wound healing and tissue viability
References
Part 7: Risk reductions
34 Cardiovascular disease risk reduction
References
35 Neuropathic complications of diabetes
References
36 Nephropathic complications
References
37 Retinal screening
38 Retinopathy
39 Liver complications
References
40 Skin conditions in diabetes
Acanthosis nigricans
Necrobiosis lipoidica diabeticorum
Lipohypertrophy
Fungal skin infections
Vitiligo
Disseminated granuloma annulare
Prevention
References
41 Sexual dysfunction in people with diabetes
References
Part 8: Other considerations
42 Travel and diabetes
References
43 Monogenic diabetes
References
44 Older people with diabetes
References
45 Cognitive decline and diabetes
References
46 End of life and diabetes
Reference
Index
End User License Agreement
List of Tables
Chapter 17
Table 17.1 Example of 24‐hour basal rates.
Chapter 19
Table 19.1 Trend arrows.
Chapter 20
Table 20.1 HbA1c and average blood glucose values.
Chapter 32
Table 32.1 Comparison of neuropathic and ischaemic ulceration.
Chapter 33
Table 33.1 Wound healing classification.
Table 33.2 Wound type.
List of Illustrations
Chapter 1
Figure 1.1 Graph to show rising HbA1c levels and diagnosis of type 2 diabete...
Figure 1.2 HbA1c.
Figure 1.3 One Less Challenge.
Figure 1.4 Signs and symptoms of metabolic syndrome.
Chapter 2
Figure 2.1 Lack of insulin causing type 1 diabetes.
Figure 2.2 Symptoms of diabetes.
Figure 2.3 Diabetes UK 4Ts campaign.
Chapter 3
Figure 3.1 How insulin resistance occurs.
Figure 3.2 Metabolic syndrome.
Figure 3.3 Signs and symptoms of metabolic syndrome.
Figure 3.4 Diagnosis of type 2 diabetes.
Figure 3.5 HbA1c.
Chapter 4
Figure 4.1 NHS England (2018)
Language Matters
.
Figure 4.2 Modelling language from
Language Matters
.
Chapter 5
Figure 5.1 The eat well plate.
Figure 5.2 Principles of healthy eating.
Figure 5.3 What is a portion?
Figure 5.4 Visual guide to what a plate could look like.
Chapter 6
Figure 6.1 Different levels of exercise intensity and their effects on the b...
Figure 6.2 MET examples.
Figure 6.3 Different examples of aerobic and anaerobic exercise.
Figure 6.4 Glucose utilization during anaerobic and aerobic exercise and aft...
Chapter 7
Figure 7.1 Classification of obesity in adults based on BMI (kg/m
2
).
Figure 7.2 Waist circumference thresholds as a measure of obesity.
Figure 7.3 Relative risk for obese people developing associated diseases.
Figure 7.4 The benefits of a 10% weight loss (10‐kg weight loss based on a b...
Chapter 8
Figure 8.1 Example of type 1 diabetes structured education content.
Chapter 9
Figure 9.1 Preventable long‐term complications of diabetes.
Figure 9.2 Fundamentals of structured education.
Figure 9.3 The aims of all structured education.
Chapter 10
Figure 10.1 Diabetes UK information prescriptions for healthcare professiona...
Figure 10.2 Diabetes UK information prescription about improving diabetes kn...
Figure 10.3 Diabetes and high HbA1c information prescription.
Chapter 11
Figure 11.1 The grief cycle of Elizabeth Kübler‐Ross (1969).
Figure 11.2 Diabetes UK 7As model.
Figure 11.3 iDEAL diabetes consultation checklist.
Chapter 12
Figure 12.1 Goal setting: three essential components.
Figure 12.2 A decision balance sheet.
Figure 12.3 Scaling tool.
Figure 12.4 SMARTER acronym.
Chapter 13
Figure 13.1 Partnerships in healthcare.
Figure 13.2 Person with diabetes at the centre of their care.
Figure 13.3 Partnership working.
Chapter 14
Figure 14.1 Summary of characteristics of drugs used in type 2 diabetes.
Chapter 15
Figure 15.1 Insulin types.
Chapter 16
Figure 16.1 Injection sites.
Figure 16.2 Correct and incorrect depth of injection needles.
Figure 16.3 Correct administration of an insulin injection using an injectio...
Figure 16.4 Correct performance of a skinfold.
Figure 16.5 Layers of skin, fat and muscle (not to scale): the tip of a 4‐mm...
Chapter 17
Figure 17.1 Insulin pump.
Figure 17.2 Insulin pod.
Figure 17.3 Infusion sites.
Figure 17.4 Basal‐bolus insulin delivery.
Chapter 18
Figure 18.1 Blood‐glucose monitoring procedure.
Chapter 19
Figure 19.1 Intermittently scanned glucose sensor: Freestyle Libre 2.
Figure 19.2 Sensor locations.
Figure 19.3 Glucose in the interstitial blood is measured.
Chapter 20
Figure 20.1 Haemogloblin A1c (HbA1c).
Figure 20.2 CGM report summary page.
Figure 20.3 Time in range.
Figure 20.4 CGM daily report.
Chapter 21
Figure 21.1 Identifying cardiovascular risk.
Figure 21.2 Why we control blood pressure.
Figure 21.3 Aims for cholesterol levels in people with diabetes.
Figure 21.4 Stages of atherosclerosis.
Chapter 22
Figure 22.1 Factors which affect blood glucose levels during the day and nig...
Figure 22.2 Symptoms of hypoglycaemia.
Figure 22.3 Progress of hypoglycaemia.
Chapter 23
Figure 23.1 Sick day management advice for type 1 diabetes.
Figure 23.2 Sick day management advice for type 2 diabetes.
Chapter 24
Figure 24.1 Comparison between DKA and HHS.
Chapter 25
Figure 25.1 Different steroids, doses and duration of action.
Figure 25.2 The effect of corticosteroids on blood glucose.
Figure 25.3 Risk factors for steroid‐induced diabetes.
Chapter 26
Figure 26.1 Changing from children to young people.
Figure 26.2 The ladder of participation in transitional care.
Chapter 27
Figure 27.1 Diabetes in preconception and pregnancy.
Chapter 28
Figure 28.1 Gestational diabetes.
Figure 28.2 NICE NG3 Guidance 2015.
Chapter 29
Figure 29.1 Pathology tests assessed at annual reviews.
Figure 29.2 Diabetes UK 9 key care processes.
Figure 29.3 LET'S TALK NOW pre‐diabetes review helpful patient guide.
Figure 29.4 Annual and interim diabetes review record sheet to share with th...
Chapter 30
Figure 30.1 Palpation of pedal pulses: (a) dorsalis pedis artery; (b) poster...
Figure 30.2 Using Doppler ultrasound in vascular assessment (shown here in a...
Figure 30.3 Using a 10-g monofilament for neurological assessment.
Figure 30.4 Risk stratification tool.
Chapter 31
Figure 31.1 The ACT NOW infographic explained.
Figure 31.2 The ACT NOW checklist, with additional prompts regarding the six...
Figure 31.3 The ACT NOW infographic.
Chapter 32
Figure 32.1 Neuropathic ulcer (after debridement).
Figure 32.2 Ischaemic ulceration (showing overlying tissue necrosis).
Figure 32.3 Infection is common in all types of ulceration, often spreading ...
Figure 32.4 The speed at which an infection can evolve in the neuropathic fo...
Chapter 33
Figure 33.1 Phases of wound healing.
Chapter 34
Figure 34.1 Stages of CVD and plaque formation.
Figure 34.2 CVD risk factors.
Figure 34.3 Specific targets in people with diabetes.
Figure 34.4 UKPDS effects on blood pressure and cholesterol.
Chapter 35
Figure 35.1 Causes of peripheral neuropathy.
Figure 35.2 Glove and stocking presentation of diabetes‐related peripheral n...
Figure 35.3 Central nervous system, demonstrating the length of the spinal n...
Figure 35.4 Characteristics of neuropathic pain.
Chapter 36
Figure 36.1 Causes of chronic kidney disease.
Figure 36.2 Risk factors for chronic kidney disease.
Figure 36.3 What are the stages of chronic kidney disease?
Figure 36.4 Test eGFR if any of these symptoms are present.
Figure 36.5 Stages of diabetes nephropathy.
Chapter 37
Figure 37.1 Snellen chart.
Figure 37.2 A retinal photograph in diabetic eye screening.
Figure 37.3 Normal retina.
Chapter 38
Figure 38.1 R1, background retinopathy:
cotton‐wool spot
s (
CWS
) and ha...
Figure 38.2 R2, pre‐proliferative retinopathy: CWS and multiple deep, round ...
Figure 38.3 R3 NVD: the optic disc shows classic neovascularization. New ves...
Figure 38.4 R3 NVE plus pre‐retinal bleed: haemorrhage occurs from the unsta...
Figure 38.5 M1 maculopathy: characterized by the distribution of exudates, a...
Chapter 39
Figure 39.1 Stages of liver disease.
Figure 39.2 Stages of liver failure.
Figure 39.3 Reversible and irreversible liver disease.
Chapter 40
Figure 40.1 Acanthosis nigricans.
Figure 40.2 Necrobiosis lipoidica diabeticorum.
Figure 40.3 Lipohypertrophy at injection sites.
Figure 40.4 Vitiligo.
Figure 40.5 Disseminated granuloma annulare.
Chapter 41
Figure 41.1 Different types of couples.
Figure 41.2 Medications that can cause sexual dysfunction.
Figure 41.3 Physical causes of sexual dysfunction in women with diabetes.
Figure 41.4 A useful questionnaire to use with women to detect sexual dysfun...
Chapter 42
Figure 42.1 Essential general travel advice.
Figure 42.2 Diabetes‐specific travel advice.
Figure 42.3 Useful travel websites for advice and information.
Figure 42.4 Medications to stop if experiencing vomiting or diarrhoea.
Chapter 43
Figure 43.1 Obtaining a family tree can be helpful in discovering monogenic ...
Figure 43.2 How to diagnose monogenic diabetes instead of type 1 or type 2 d...
Figure 43.3 Monogenic diabetes.
Chapter 44
Figure 44.1 Dry eyes.
Figure 44.2 Dry skin.
Figure 44.3 Frailty and diabetes.
Figure 44.4 Polypharmacy is a risk for hypoglycaemia.
Chapter 45
Figure 45.1 Cognitive decline and dementia.
Figure 45.2 Alzheimer's disease and vascular dementia.
Figure 45.3 Symptoms of vascular dementia.
Figure 45.4 Treatments.
Chapter 46
Figure 46.1 Trend Diabetes
End of Life Guidance for Diabetes Care
.
Figure 46.2 End‐of‐life care.
Guide
Cover Page
Title Page
Copyright Page
Dedication Page
Contributors
Acknowledgments
Table of Contents
Begin Reading
Index
Wiley End User License Agreement
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Diabetes Careat a Glance
Edited by
Anne PhillipsPhD, MSc, NTF, RNT, QN, BSc Hons, NDN, RGN
Professor in Diabetes Care
Programme Lead for Advancing Diabetes Care
Birmingham City University, Edgbaston
Birmingham, UK
Series Editor: Ian Peate
This first edition first published 2023© 2023 by John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Anne Phillips to be identified as the author of the editorial material in this work has been asserted in accordance with law.
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Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data applied forPaperback ISBN: 9781119841265
Cover Image: © John Fedele/Getty ImagesCover design by Wiley
This textbook is for every practitioner who would like to learn more about caring for people with diabetes and may see this specialism as an exciting career prospect to follow – we encourage you and thank you.
This textbook is also dedicated to Sandra Dudley, a dedicated Diabetes Specialist Nurse who spent her career working with people with diabetes and latterly introducing insulin pump therapy back into the UK. Sandra made a substantial difference to every person with type 1 diabetes she met and cared for – thank you Sandra.
Contributors
Julie Cropper [Chapter 43]Genetic Diabetes Nurse/North East and Yorkshire GMSA Nurse Lead, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Adele Farnsworth [Chapters 37, 38]Senior Diabetic Retinal Screener and Grader, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Carole Gelder [Chapter 26]Children’s Diabetes Specialist Nurse and Clinical Educator, Leeds Children’s Hospital, Leeds and Senior Lecturer, Birmingham City University, Birmingham, UK
Peter Jennings [Chapters 2, 13, 17, 19, 20]Senior Lecturer for Advancing Diabetes Care, Birmingham City University, Birmingham, UK
Aoife Kelleher [Chapter 43]Consultant in Paediatric Diabetes, Leeds Children’s Hospital, Leeds, UK
Angela Phillips [Chapter 39]Diabetes Specialist Nurse, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Anne Phillips [Chapters 1, 3, 4, 6, 10–13, 21, 22, 29, 34, 35, 41, 42, 44, 45]Professor in Diabetes Care, Programme Lead for Advancing Diabetes Care, Birmingham City University, Edgbaston, Birmingham, UK
Paul Pipe‐Thomas [Chapters 5, 7, 9]Clinical Specialist Dietitian for Diabetes, Rotherham NHS Foundation Trust, Rotherham, UK
Jayne Robbie [Chapters 30–33, 40]Senior Lecturer in Advancing Diabetes Care, Birmingham City University and Specialist Podiatrist, University Hospitals Birmingham NHS Trust, Birmingham, UK
Susan Sapayi [Chapter 36]Diabetes and Renal Specialist Nurse, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Theresa Smyth [Chapters 27, 28, 46]Nurse Consultant in Diabetes, University Hospitals Birmingham NHS Foundation Trust and Honorary Visiting Professor, Birmingham City University, Birmingham, UK
Martha Stewart [Chapters 8, 14–16, 18, 23–25]Senior Lecturer in Advancing Diabetes Care, Birmingham City University, and Diabetes Clinical Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Alex Wright [Chapters 37, 38]Retired Consultant Diabetologist and Diabetic Eye Disease Specialist, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Acknowledgments
The Editor and authors wish to donate all Book royalties to the International Diabetes Federation Life for a Child https://www.idf.org/our‐activities/humanitarian‐action/life‐for‐a‐child.html.
We wish to thank Richard Smith, Academic Learning Technologist, BCU, who gave enormous help with the illustrations.
Part 1Introduction
Chapters
1
Diabetes Prevention
2
Diagnosis of Type 1 Diabetes
3
Diagnosis of Type 2 Diabetes
4
Consultation Approaches and Language Matters
1Diabetes prevention
Figure 1.1 Graph to show rising HbA1c levels and diagnosis of type 2 diabetes.
Figure 1.2 HbA1c.
Figure 1.3 One Less Challenge.
Source: Africa Studio/Adobe Stock.
Figure 1.4 Signs and symptoms of metabolic syndrome.
This chapter is to help you understand what diabetes prevention involves and how you can help people at risk of type 2 diabetes to reduce their risk. A record number of people across the UK and worldwide are living with type 2 diabetes, and this figure has more than doubled since 1996. The International Diabetes Federation (IDF 2021) reported that 537 million people are known to have diabetes worldwide, with predictions that this will rise to 783 million by 2045.
Type 2 diabetes is largely preventable, and the World Health Organization (WHO 2019) has recognized that diabetes predominantly affects people who are most vulnerable, with three in four adults with diabetes aged 20–79 living in low‐ and middle‐income countries. Diabetes costs the worldwide healthcare system at least £720 billion, a rise of 316% in total health expenditure since 2006.
Every two minutes someone discovers they have type 2 diabetes, a serious health condition that can cause long‐term health problems. Type 2 diabetes causes about 90% of all types of diabetes worldwide. Intervention to prevent type 2 diabetes and target those most at risk of non‐diabetic hyperglycaemia should be timely and outcomes can be favourable with early intervention and referral for people this affects.
Diabetes prevention programmes are becoming increasingly available worldwide. The programme in the UK is organized by NHS England, Public Health England and Diabetes UK and delivers a behavioural platform to support people in reducing their risk of developing type 2 diabetes, or in reversing the diagnosis if newly diagnosed. This programme is provided nationwide, and people can be referred via their GP practice or secondary care. The programme is delivered by different providers in primary care networks (PCNs) and involves a group class, a health coach and/or access to a personalized app to help motivate the patient to lose weight and be more physically active.
People are at risk when the level of HbA1c (an average of the last six to eight weeks of blood glucose levels) is raised (World Health Organization 2011). The diagnostic level of HbA1c for type 2 diabetes is 48 mmol/mol. Non‐diabetic hyperglycaemia is diagnosed at 42–77 mmol/mol and this places people ‘at risk’ for type 2 diabetes (Figure 1.1). The interval from the onset of rising HbA1c levels to the diagnosis of type 2 diabetes is on average seven years; this period is a window of opportunity that allows the detection of non‐diabetic hyperglycaemia and appropriate prevention strategies to be offered. Measurement of HbA1c is usually undertaken during a routine health review in general practice but might also take place during a preoperative screening or as part of an inpatient biochemistry profile.
HbA1c reflects the amount of glucose that binds to red blood cells (RBCs) when they are manufactured in the bone marrow. The blood glucose level at the time the RBCs are produced is the amount that binds to those RBCs for their lifespan, on average 12 weeks (Figure 1.2). Thus an HbA1c measurement comprises some older RBCs, some newer ones and some middle‐aged ones, so that the HbA1c value is considered the average of all these RBCs, thus allowing six to eight weeks of glucose control.
The NHS National Diabetes Prevention Programme (Diabetes 2022) in the UK focuses on three main goals of behavioural intervention: (i) weight loss, (ii) achievement of individualized dietary recommendations, and (iii) achievement of recommended individualized physical activity recommendations. Person‐centred goal setting with each individual is essential to engage people with their programme and to support each individual in achieving their personal goals in diabetes prevention and health gain. One approach for weight loss is to recommend ‘one less’ as this can be easily understood and can be meaningful for people to engage with. For example, one less slice of bread is equivalent to a saving of 32 kcal, and over seven days this amounts to 224 kcal less consumed (Figure 1.3). This can be adapted into people's daily routines and built upon by individuals as they achieve some weight reduction.
Screening people for diabetes can help to find people at high risk. Health professionals have a number of strategies to try to prevent type 2 diabetes and engage people in their own personal health. The Diabetes UK three‐minute ‘at risk’ assessment is a good approach to use (https://riskscore.diabetes.org.uk/start) as this is individualized and offers support for people in their own homes (Figure 1.4).
References
Diabetes UK (2022). NHS Diabetes Prevention Programme.
www.diabetes.org.uk/professionals/resources/shared‐practice/nhs‐diabetes‐prevention‐programme
(accessed 1 April 2022).
International Diabetes Federation (2021).
IDF Diabetes Atlas
, 10e.
https://diabetesatlas.org
(accessed 1 April 2022).
World Health Organization (2011).
Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Abbreviated report of a WHO consultation
. WHO/NMH/CHP/ CPM/11.1. Geneva: World Health Organization
https://apps.who.int/iris/handle/10665/70523
(accessed 1 April 2022).
World Health Organization (2019). Diabetes.
www.who.int/news‐room/fact‐sheets/detail/diabetes
(accessed 1 April 2022).
2Diagnosis of type 1 diabetes
Figure 2.1 Lack of insulin causing type 1 diabetes.
Figure 2.2 Symptoms of diabetes.
Figure 2.3 Diabetes UK 4Ts campaign.
Type 1 diabetes is an autoimmune disease that develops when the body attacks and destroys approximately 80–90% of the beta cells in the pancreas that produce insulin. As a result of no longer producing insulin, most people with type 1 diabetes must inject insulin (see Chapter 16) every day throughout their lives or wear a small pump that continuously infuses insulin (see Chapter 17). A tiny proportion of people have new beta cells transplanted so they no longer require daily insulin replacement. Why the body attacks its beta cells is not fully understood, but genetics and environmental factors increase the risks.
The absence of insulin production in the pancreas (Figure 2.1) means that glucose cannot be absorbed from the bloodstream and the blood glucose level rises above the normal range (note that the term ‘blood glucose’ is commonly used to refer to plasma glucose levels). In people without type 1 diabetes, normal fasting blood glucose levels range between 4.0 and 5.4 mmol/l and can rise up to 7.8 mmol/l two hours after eating. Someone with newly diagnosed type 1 diabetes may present with high blood glucose levels (hyperglycaemia) ranging from 8 to 30 mmol/l or more.
The common signs and symptoms of type 1 diabetes are caused by a lack of insulin and the resulting high glucose levels (Figure 2.2
