Type 2 Diabetes

it is when the body either doesn't make enough insulin or the body becomes resistant to insulin, so it doesn't work properly.

- people who are over 40 years old. - people who have a relative with the condition = genetic. - south Asian, African, Caribbean or middle eastern people. - overweight or obese people.

AGE- risk increases with age. -people tend to gain weight and exercise less as they get older. GENETICS - a child who has a parent with type 2 diabetes has a 1:3 chance of developing diabetes. ETHNICITY- six times more common in south Asian communities. BEING OVERWEIGHT OR OBESE - if you have a body mass index of 30 or over. -fat around tummy increases risk, it releases chemicals that can upset the bodies cardiovascular and metabolic systems causing insulin not to its job. -the muscle/ cell tissue can get 'furred up' with fatty deposits, so the glucose cant pass into cells of the body.

often slower onset- happens over a period of time (unlike type 1 which are sudden on set) - feeling thirsty - urinating frequently, more than normal. - feeling tired - weight loss and loss of muscle bulk -early symptoms can be mild.

- URINE AND BLOOD TESTS . urine tested to see if it contains glucose sugar. . urine does not normally contain glucose. . morning urine sample normally tested. followed by a blood sample to see if blood contains any glucose. - if blood glucose levels are not high enough A GLUCOSE TOLERANCE TEST CAN BE DONE = drinking a glucose drink, then every 1/2 hour blood test done to see how body is dealing with sugar in the drink. . for someone without diabetes, the amount of glucose in blood should be: less than 6 mmol// before test and 7.8 mmol/l 2 hours after the test. .but if a person has impaired glucose tolerance (IGT) their readings could be: = 6-7 mmol/l before the test = 7.9 - 11 mmol/l 2 hours after the test . if they have diabetes their readings will be: =more than 7 mmol/l before test. = more than 11 mmol/l 2 hours after test.

- if the patient has IGT they are advised to make lifestyle changes (regular exercise, healthy eating and losing weight), and take medication to lower blood glucose may also be recommended. - type 2 diabetes usually gets worse overtime. so if results indicate diabetes, medication will be prescribed to lower glucose levels and to help keep it under control.

-REGULAR EXERCISE = lowers blood glucose levels and the need for insulin to change glucose into glycogen in the liver and muscle tissues (less demand on the liver). - aim to do 2 1/2 hours of exercise per week. - EATING HEALTHY = a healthy diet rich in high fibre (slow release of energy into blood), fruit and vegetables, but low in fat, sugar and salt. - LOSING WEIGHT = reducing BMI to within a healthy range. - LIMIT ALCOHOL INTAKE = drinking in moderation and never drinking on an empty stomach. - alcohol can cause either high or low blood glucose levels.

- SELF CARE = taking responsibility for own health and well being, can receive self-care support. - REGULAR REVIEWS = regular contact with diabetes team, develop good relationships, discussing concerns, etc. - HEALTHY EATING = healthy eating, having a diet rich in high fibre, fruit and vegetables but low in fat, sugar and salt. - REGULAR EXERCISE = a physical activity lowers your blood glucose level, it is very important to exercise regularly if you have diabetes. - 2 1/2 hours of moderate intense activity a week. - as exercise will affect your blood glucose level, the care team may have to adjust insulin treatment. - DO NOT SMOKE = having diabetes increases your risk of developing a cardiovascular disease, such as a heart attack or stroke. - as well as smoking increasing this risk further, smoking can also increase your risk of other conditions, such as lung cancer. - LIMIT ALCOHOL = drink alcohol in moderation and never drink alcohol on an empty stomach. depending on the amount of alcohol drank it can cause either high or low glucose levels. - KEEPING WELL = people with long term conditions are encouraged to get the flu jab to keep other illnesses and infections away. -LOOK AFTER YOUR FEET = having diabetes means you are more likely to develop problems with your feet, including foot ulcers and infections from minor cuts and grazes. this is because diabetes is associated with poor blood circulation in the feet and blood glucose can damage the nerves in your feet. -REGULAR EYE TESTS = if you have type 2 diabetes you should have your eyes tested at least once a year to check for retinopathy. - retinopathy is an eye condition where the small blood vessels in your eye become damaged, due to your blood glucose being too high for a long period of time. if retinopathy is left untreated it can cause blindness. - PREGNANCY = if pregnant you will need to keep your blood glucose under tight control, before pregnancy and during first 8 weeks of baby's development to reduce risks of birth defects. - medications need to be checked as they could harm the baby. - take a higher dose of folic acid tablets to prevent baby developing spinal cord problems. having eyes checked as pregnancy puts extra pressure on small vessels in your eye.

- an ophthalmologist = a specialist who deals with eye care. - an optometrist = a doctor who specialise in eyes and vision care. - a practise nurse = works in GP surgery as part of primary health care team, which might include doctors, pharmacists and dieticians. - a pharmacist = who works in a chemist and gives people medication. - a podiatrist = a specialist in feet. - a psychologist = provides counselling and psychotherapy, works with people who have life adjustment problems. - a registered dietician = experts in food and nutrition. - a diabetologist = a medical professional who provides care and advice to people with diabetes. - GP = doctor - health visitor = deals with people under 16 - diabetes specialist nurse = often the most important source of information for all practical aspects of diabetes.

if diabetes isnt treated, it can lead to a number of other health problems: - high glucose levels can damage blood vessels, nerves and organs. -heart disease and strokes: . 5 times more likely to develop heart disease or stroke if you have diabetes. . poorly controlled glucose levels can lead to furring of the arteries. . poor blood supply to heart can cause angina. - retinopathy = retina (light sensitive layer of tissue) at the back of the eye is damaged. the better controlled the glucose levels are the less damage - kidney disease if small vessels in kidney become blocked will be less efficient. - foot problems = damage to the nerves of the foot can mean that the small nicks and cuts are not noticed, which can lead to foot ulcers.

- may feel socially isolated because they are different to others. - have to watch alcohol intake when socialising with friends, so may put them off going out as it can affect glucose levels. - make new friends= with others who have diabetes.

- retinopathy = if blood glucose levels aren't controlled . - can damage blood vessels, nerves and organs. - kidney disease = if small vessels get blocked. - foot problems = damage to nerves. - more physically active due to lifestyle changes.

- self concious about being different to everyone else and having to constantly monitor blood glucose levels. - depressed to know it can be caused by weight and lack of exercise.

- learn more about the condition and how to manage diet and lifestyle changes. - illnesses and hospital appointments can cause time off work or education.

- income may drop due to time taken off from work. - hospital car park changes

1. the GP / practise nurse will ask personal and family history and symptoms. 2. the GP will carry out a urine test for the presence of glucose in the urine. a blood test will also be done to measure blood sugar levels. also glucose tolerance tests may be carried out if the blood glucose levels aren't high enough, this will see how body deals with sugar. 3. once diabetes has been confirmed, the nature of the condition and its management should be sensitively explained. 4. education and information about diabetes is given and its management in the form of leaflets. the future lifestyle changes are also discussed and patient is given support.

the patient will be placed at the centre of all care processes: RESPONSIBILITY = the patient is given responsibility to make lifestyle changes to improve health and diabetes. SUPPORT AND ADVICE = the patient is given all information about diabetes, given leaflets and advice about lifestyle changes. CHOICE AND DECISION MAKING = the patient is involved with all the decision making that is made about managing diabetes and healthy lifestyle. EMPOWERMENT = it is important that the patient is given empowerment so they feel confident about them selves and don't feel different to others.