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Lecture 5
Diabetes
Trend are identified from studying large groups of people with diabetes This information is not necessarily applicable to any specific individuals Many factors affect the course of illnesses Anyone with concerns following this lecture are welcome to discuss these with me
Food enters digestive system Sugar absorbed through intestines into blood
Pancreas
Blood carries sugar to cells
Insulin
What is Diabetes?
Comprises a group of disorders characterised by raised levels of blood glucose Usually blood sugar levels: 3.5 to 6.5 mmol/l High blood sugar because pancreas cannot produce enough insulin (type 1) or is resistance to it (type 2) Insulin is the hormone responsible for the converting blood sugar into useful energy
History
References as early as 1552 BC to diabetes noted symptoms included: polyuria; weight loss, excessive thirst, sweet tasting urine, fatigue 1889 Mehring and Minkowski create diabetic dog by removing its pancreas 1921 Banting, Best, Collip & McLeod identify insulin & treat successfully depancreatised dog 1922 Leonard Thomson, 14 yo, weighing 65lb successfully treated
Type 1 Diabetes
Insulin Dependent Diabetes Mellitus Used to be called juvenile onset diabetes Most commonly begins during childhood Cells that produce insulin in the pancreas have been destroyed by the immune system Accounts for about 15% of people with diabetes Before & after insulin tx Best & Banting Need daily injections of insulin to survive
Type 2 Diabetes
Pancreas doesnt produce enough insulin or cells ignore it (insulin resistance)
Prevalence
About 3% of those UK have diabetes Type 2 rate = 0.4% in children & 10% in those over 65 Type 2 more common in those of African, Aboriginal & Hispanic descent in West About half undiagnosed Rates increasing - set to double over next 15 years Increasing incidence parallels that of obesity (e.g. Massachusetts: 1958 - 0.9%; 1995 - 3%)
Generally occurs in those over 40 years old Associated with obesity & runs in families to some extent Build-up of glucose more slow often unnoticed 30%-50% will require insulin injections Lifestyle issues prominent
Aetiology
Type 1 Genetics Environment Hypothesis ~30% risk in monozygots Virus, diet, stress Destruction of pancreatic cells Type 2 ~100% risk in monozygots Obesity, age, malnutrition in- utero Various
Treatments
8 6 4
Insulin
Diet
Exercise
NHS Costs
5% of total costs & 10% of in-patient costs on diabetes care
Most costs are associated with complications Presence of complications = 5 times the cost, e.g., 5 times as likely to be admitted to hospital & stay twice as long
Summary
Type 1 & 2 diabetes are chronic illnesses Those with diabetes need to keep blood sugar levels within certain ranges by manipulating insulin, diet and exercise continually If not the cost in human terms can be substantial The primary determinant of longer-term health is the self-care behaviour of people with diabetes
Psychological Issues
Barriers to self-care 1. Depression 2. Stress & Anxiety 3. Fear of Hypoglycaemia 4. Lifestyle change
Depression - Symptoms
Psych. symptoms include: low mood; loss of interest; social withdrawal; worthlessness, guilt, low motivation Cognitive Triad Negative View of Self Negative View of World Negative View of Future
Fear of Hypoglycaemia
Fear of unpleasant symptoms of very low blood sugars Typical stress reactions of hypervigilence & avoidance
Trigger Bedtime blood sugar checks reading of 13% Thought (Illness Cognitions) What if something happens; Im all alone; Ill have some toast just in case Behaviour Has few slices of toast just in case Result High blood sugars next morning
Trigger Awaiting presenting @ work meeting Emotions Thoughts My blood sugars are low; I need to do something; I m going to faint Anxiety Fear Stress Symptoms Sweating Blurred vision Shaking
Lifestyle Change
Reflect culture, personal beliefs, choices & self-efficacy General finding is that periodic boosters are probably required for many Often not delivered effectively by diabetes services Other issues also influential (as mentioned) Exercise, diet, alcohol intake, smoking etc.
Summary
Diabetes is a chronic illness that impacts on all aspects of life
Treatments include insulin & adjusting lifestyle People with diabetes are responsible for this & thus are the primary determinant of longer-term health The costs in human & financial terms of poor control are great As self-care is paramount, psychological issues are fundamentally influential in current & long-term health Control improves by addressing barriers to self-care
The End