Diabetes – Treatment , Complication and Prevention of Diabetes – An interview with Dr Max Pemberton

Diabetes - Treatment , Complication and Prevention of Diabetes - An interview with Dr Max Pemberton
Diabetes – Treatment , Complication and Prevention of Diabetes – An interview with Dr Max Pemberton

A few weeks ago we were delighted to be able to interview Dr Max Pemberton about the key questions many of us has about diabetes.

We covered one of these topics in a post a few days ago because we felt that the definition of type 1 , type 2, type 3 and type 1.5 (as well as gestational diabetes and pre-diabetes)  was important enough to cover in its own post. You can check it out here.

Today we want to look at the treatments and complication of diabetes. So we lined up Max for a few more questions.

Diabetes Treatments

Patient Talk:- What are the treatments available for diabetes?

Max Pemberton:- So in recent years there’s been loads of developments in the way that we manage diabetes. As well as making key lifestyle changes, people with both Type 1 and Type 2 diabetes often need additional treatments such as medication like insulin to control their diabetes as well as things like their blood pressure and their blood fats so that’s their cholesterol.

Complications of Diabetes

Patient Talk:- Would you be able to elaborate on some of the complications of diabetes?

Max Pemberton:- So this is really important and this is why we take blood glucose levels so seriously is because if particularly, people have high blood glucose levels over long periods of time, it can cause really serious physical health complications and they include things like damage to blood vessels so that people are at increased risk of strokes and heart attacks. It can also cause damage to the very fine delicate blood vessels so that can cause problems with people’s kidneys. It can also cause problems with people’s eyesight so a condition called diabetic retinopathy whereby the delicate blood vessels at the back of the eye have problems and it can result in blindness. In fact it’s the leading cause of blindness in the UK. It can also develop things to do with circulation in the legs, for example where people can develop ulcers and in really extreme circumstances the circulation is so bad that people actually have to have their legs amputated.

Diabetic retinopathy and Diabetic foot ulcers

Patient Talk:- Explain what diabetic retinopathy and diabetic ulcers are?

Max Pemberton:- Diabetic retinopathy as I say it’s the leading cause of blindness in the UK so it’s so important that people get checked for this. On the NHS, everybody with a diagnosis of diabetes is entitled to free eye checks and I cannot emphasise enough the importance of going regularly to the optician to get your eyesight checked and make sure that this isn’t happening. If it is happening there’s tweaks and changes that can happen to your medication. Better blood glucose control can help it and various other procedures that doctors can do but it really is absolutely key that people are getting this monitored and also the same with the diabetic ulcers – so foot ulcers where the skin breaks down and forms an open sore and because of the difficulties of circulation they can take a really long time to heal. Sometimes they can be started by very small, tiny cuts or relatively insignificant wounds and one of the problems with diabetes is that some of the change that happens to circulation can also affect the very fine delicate nerves that are in the bottom of the feet so that often people can have damage to their feet – they stand on a drawing pin for example – and because the nerves in their feet aren’t working quite as well as they should do, they don’t actually feel it, they don’t realise that they’ve caused any damage and then that over time can develop into an ulcer. So again that’s why it’s really important that people with a diagnosis of diabetes go regularly to the chiropodist or podiatrist and they are entitled to free foot care on the NHS.

Prevention of Diabetes

Patient Talk:- In terms of lifestyle, what can be done to prevent diabetes? Are there any suggestions or advice?

Max Pemberton:- So there’s a whole range of lifestyle changes that can be made. So losing weight is really important, doing regular exercise, and also if you know family members who have a diagnosis of diabetes already it is important that you go regularly to the doctor to see whether or not you need to get checked to see if you’ve got diabetes. It’s not always obvious when somebody first develops it. The kind of typical presentation, things like feeling thirsty or tired or weight loss, they only happen to about half of patients, the other half have diabetes and they’re not aware of it and it’s picked up on routine screening. If people want more information there’s a website that’s being setup specifically to help people understand this delicate balance that has to take place when you have diabetes between the high blood glucose and the low blood glucose levels and that website is www.diabeteshighsandlows.co.uk

Fear and shame leading to people with Type 2 diabetes risking future life threatening conditions

diabeteshighsandlows.co.uk
diabeteshighsandlows.co.uk
  • Research amongst patients with Type 2 Diabetes on insulin reveals how emotional and psychological factors are negatively impacting their condition
  • A quarter suffer from anxiety over getting hypos (low blood glucose levels) with more than 40% preferring to have high blood glucose levels instead of risking another hypo. This can lead to serious long term health risks
  • A new campaign launches today called ‘Diabetes Highs & Lows: Better Balance for a Better Future’ which highlights how emotional and psychological factors can have an impact on effective T2 diabetes management
  • The campaign includes the launch of a patient support website, DiabetesHighsAndLows.co.uk which is dedicated to helping patients with T2 diabetes better manage their blood glucose levels. The website is developed and funded by Sanofi.

A quarter of people with T2 diabetes feel anxious or fearful about ‘hypos’ (low blood glucose levels), with 42% preferring to have high blood glucose levels instead, despite the risk of life threatening conditions in the future.[i]

The findings also revealed that a significant proportion of patients with T2 diabetes believe that other people think they are to blame (15%), and some patients believe that other people think they are just greedy (14%) 1 . Likewise, 25% of patients with T2 diabetes only tell close friends, family or their healthcare professional about their diabetes, and 58% feel self-conscious or avoid injecting in front of other people, negative emotions are stopping people managing their condition properly.[i]

 Another Sanofi-funded study conducted in adults with Type 1 and Type 2 diabetes in the UK, and  published in the journal Diabetic Medicine, showed even modest improvement in blood glucose control could help prevent almost a million serious medical complications such as eye disease, kidney disease, foot ulcer and amputations, and potentially blindness, which could  avoid billions in future NHS costs.[ii]

With the UK having the worst control of T2 diabetes blood glucose levels in Europe[iii], Sanofi, who conducted the report, is launching a new patient support website to help the 52% of T2 diabetes patients who find it hard to balance their blood glucose levels.[i]

The Sanofi ‘Diabetes Highs and Lows: Better Balance for a Better future’ campaign aims to help people with Type 2 diabetes feel in control and positive about how they can balance their blood glucose levels. A new website, developed and funded by Sanofi has been launched, diabeteshighsandlows.co.uk, which includes key information on recognising and managing blood glucose highs and lows.

[i] Sanofi Data on File 2016. “Highs and lows: better balance for a better future” market research

[ii] Baxter et al, Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the

number of clinical complications and the associated financial benefit. Diabetic Medicine (2016). DOI: 10.1111/dme.13062

[iii] Khunti K et al. Study of Once Daily Levemir (SOLVETM) insights into the timing of insulin initiation in people with poorly

controlled Type 2 diabetes in routine clinical practice. Diabetes, Obesity and Metabolism (2012)

Diabetes – so what are Type 1, Type 2, Type 3, Type 1.5 and gestational diabetes? (and pre-diabetes as well)

Doctor Max Pemberton
Doctor Max Pemberton

One of the big confusions, for a lot of people, is what are the different types of diabetes. In fact a lot of people have never heard of type 1.5 and type 3 diabetes. So we though we would ask Dr Max Pemberton who is an expert in this field!

He told us “I think this causes people a lot of confusion. There’s three main ones – Type 1, Type 2 and gestational diabetes and they’re all quite different. Type 1 diabetes is caused by an immune response whereby the body creates antibodies to the cells that make insulin in the pancreas, and it destroys those cells. So people with Type 1 diabetes no longer have the cells that make insulin, and so therefore they have low or no insulin in their blood.

Type 2 is quite different and that’s where the cells in the body have become resistant to the effects of insulin, so their body still makes insulin but the cells aren’t responding to it in the way that they should.

Now, gestational diabetes, that refers to a condition where women who are pregnant can sometimes develop diabetes and it’s just for the time that they are carrying a baby. So when they then give birth the majority of them, the diabetes then sort of passes. It’s really a response to being pregnant and the physical and hormonal changes that take place. People with gestational diabetes are at risk in the future of possibility developing diabetes but it is one of those things at the time, it then does go.

Now there’s these other terms that you mention, 1.5 and Type 3 and to be honest these complicate matters a bit. So all that 1.5 means really, it used to be thought that Type 1 diabetes affected people when they were very, very young and that’s when they first got diagnosed with it, and Type 2 was a result of lifestyle like being obese and so on, and that tended to happen when people were much older. Actually what they realised, that there is a group of people who despite might be relatively normal weight, they don’t have high cholesterol and so on and so on, so relatively physically healthy and yet still it’s often in their 40s or so they develop diabetes. So it’s not clear if it’s because of lifestyle changes, and it’s got a component probably of auto immune to it but it’s just presented much later, so it sits in-between Type 1 and Type 2 so they call it Type 1.2. To be honest I don’t think it is particularly helpful, I think it just confuses people.

Type 3 again I find it a slightly confusing term. It’s used by researchers just to talk about the evidence that shows that in some types of Alzheimer’s, the brain has become resistant to the effects of insulin. It’s just purely one of those scientific anomalies no one really quite understands quite what this means or the implications for either Alzheimer’s or indeed diabetes, but it’s one of these things you hear very occasional, sort of banded around usually within academic circles. It’s not something to worry about. Personally I definitely don’t think about Type 3 diabetes. The main three don’t forget are Type 1, Type 2 and gestational diabetes. ”

We also asked for a definition of pre-diabetes.  Max told up “Although there are three main types of diabetes, there’s also a stage before diabetes and that’s called pre-diabetes. It’s noticed impaired glucose tolerance and it’s a condition where your blood “

Lifestyle Tips To Improve Circulation

Poor circulation is associated with a number of different medical conditions such as diabetes, obesity and Raynaud’s disease.

But plenty of us suffer from poor circulation so we thought we would share this useful infographic with a few useful lifestyle hits on how to improve your circulation.

 Lifestyle Tips To Improve Circulation (Infographic)
Presented By Therapy Stockings Compression Garments

World Diabetes Day 2016 – The Highs and Lows of Type 2 Diabetes Video

World Diabetes Day 2016
World Diabetes Day 2016

Sanofi today announced that new research reveals that negative emotions are jeopardising people living with Type 2 diabetes’ ability to effectively manage their condition. A quarter of people with T2 diabetes feel anxious or fearful about getting ‘hypos’ (low blood glucose levels), with 42% preferring to have high blood glucose levels instead of risking another ‘hypo’, despite this risking life threatening conditions in the future.

UK adults with Type 1 and Type 2 diabetes showed even modest and sustained improvement in blood glucose control could help prevent almost a million serious medical complications such as eye disease, kidney disease, foot ulcer and amputations, and potentially blindness, which could avoid billions in future NHS costs.

Blood sugar: Lowest % of T2s with low blood sugar (5 worst areas of UK for blood sugar management)
• Bristol (45.1%)
• North East Essex (41.6%)
• Central Manchester (40.1%)
• South Reading (40%)
• Kernow (40.9%)

Prevalence: Highest % of people with diabetes (5 areas with highest rates of diabetes in UK)
• Bradford (9.7%)
• Sandwell and West Birmingham (9%)
• Walsall (8.7)
• Harrow (8.7)
• Leicester City (8.9)

The UK has the worst T2 diabetes blood glucose levels in Europe, Sanofi is launching a new campaign dedicated to helping patients – ‘Highs & Lows: Better Balance for a Better Future’, thatincludes a patient support website, to help the 52% of patients with T2 diabetes who find it challenging to balance their blood glucose levels or who worry about doing so