Additional Information
Book Details
Abstract
If you have recently been diagnosed with type 2 diabetes, you will need to make some changes in your life that seem unwelcome and unnecessary. There is a wide range of treatments for this form of diabetes, from dietary adjustment and increased activity through to tablets and the use of insulin. Each new stage can lead to anxiety and a feeling that you are not in control.
The best way to deal with diabetes is to develop a thorough understanding of the condition and how it affects you personally. This comprehensive reference book will provide you with all the information you need to put you in the driving seat so you can cope with any eventuality you may encounter.
Controlling your diabetes is the key to avoiding long-term health problems. If you can follow a healthy diet, control your weight and understand your medications you can look forward to good health and well-being for many years to come!
With this practical book you can take control of your health in the best way possible, because the greatest expert on your diabetes should be you.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Type 2 Diabetesin Adults of All Ages: How to become an expert on your own diabetes | Cover | ||
| Half Title Page\r | i | ||
| Title Page | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Preface | xvii | ||
| 1. Introduction | 1 | ||
| 2. Getting to grips with diabetes | 4 | ||
| When you first find out you have diabetes | 4 | ||
| Structured patient education programmes | 5 | ||
| DESMOND | 5 | ||
| DESMOND topics covered at the newly diagnosed patients’ session | 5 | ||
| X-PERT | 6 | ||
| Coming to terms with the diagnosis | 6 | ||
| What happens next? | 6 | ||
| Older people | 7 | ||
| Teenagers and young adults | 7 | ||
| Self-help groups | 7 | ||
| Routine check-ups | 7 | ||
| Living the life you choose | 9 | ||
| 3. Caring for your own diabetes | 10 | ||
| Goals for managing diabetes | 10 | ||
| How can you achieve these goals? | 11 | ||
| Traditional approach | 11 | ||
| Diabetes today – cornerstones of management | 11 | ||
| Becoming your own expert | 12 | ||
| Can you take time off from diabetes? | 13 | ||
| Alternative and complementary therapies | 13 | ||
| Bitter gourd or bitter melon | 14 | ||
| 4. Diabetes: some background | 15 | ||
| Insulin history | 15 | ||
| Type 1 diabetes | 15 | ||
| Type 2 diabetes | 16 | ||
| Risk factors for Type 2 diabetes | 16 | ||
| Non-insulin treatments for Type 2 diabetes | 16 | ||
| Young people with Type 2 diabetes | 17 | ||
| Principles of treatment for Type 2 diabetes | 18 | ||
| Maturity-onset diabetes of the young (MODY) | 18 | ||
| Latent autoimmune diabetes in the adult (LADA) | 18 | ||
| How common is diabetes? | 18 | ||
| Can you catch diabetes? | 19 | ||
| Does eating too much sweet food cause diabetes? | 19 | ||
| 5. How your body works | 20 | ||
| Phases in glucose metabolism | 20 | ||
| How insulin works | 21 | ||
| Insulin | 21 | ||
| What happens to the carbohydrates in the food? | 24 | ||
| Your body doesn’t realise it has diabetes | 25 | ||
| Diabetes, insulin deficiency and insulin resistance | 25 | ||
| 6. Regulation of blood glucose | 26 | ||
| Where does the glucose in your blood come from? | 26 | ||
| Counter-regulatory hormones that increase blood glucose levels | 27 | ||
| Effects of insulin | 27 | ||
| The liver | 27 | ||
| Body reserves during fasting and hypoglycaemia | 27 | ||
| Liver and muscle stores | 28 | ||
| Glucagon | 28 | ||
| Glucagon injections | 29 | ||
| The effects of glucagon | 29 | ||
| Adrenaline | 29 | ||
| Effects of adrenaline | 30 | ||
| Cortisol | 30 | ||
| Effects of cortisol | 30 | ||
| Growth hormone | 30 | ||
| The effects of growth hormone | 31 | ||
| 7. High blood glucose levels | 32 | ||
| Insulin resistance – not enough insulin to do the job? | 32 | ||
| Early need for insulin in Type 2 diabetes | 33 | ||
| What to do about a high blood glucose level | 33 | ||
| Diet alone | 33 | ||
| Anti-diabetes tablets | 33 | ||
| Symptoms of persistently high blood glucose | 34 | ||
| Insulin treatment | 34 | ||
| Hyperglycaemic hyperosmolar state (HHS) | 34 | ||
| Ketoacidosis | 35 | ||
| Blurred eyesight and diabetes | 36 | ||
| 8. Nutrition | 37 | ||
| The eatwell plate | 37 | ||
| What is our food made of? | 38 | ||
| Aims of nutritional management | 38 | ||
| How can this be achieved? | 39 | ||
| Absorption of carbohydrates | 39 | ||
| Glycaemic index | 40 | ||
| Factors that raise the blood glucose level more quickly (increase the glycaemic index) | 41 | ||
| Factors that raise the blood glucose level more slowly (decrease the glycaemic index) | 41 | ||
| Carbohydrates | 42 | ||
| Glycaemic index | 43 | ||
| Emptying the stomach | 44 | ||
| How is the emptying of the stomach affected? | 44 | ||
| Gastroparesis | 45 | ||
| Taking fluids with food | 45 | ||
| Dietary fibre | 46 | ||
| Sugar content of our food | 46 | ||
| Dietary fats | 47 | ||
| Food rules of thumb | 47 | ||
| Food choices and diabetes | 47 | ||
| Potatoes | 47 | ||
| Bread | 48 | ||
| Cereal | 48 | ||
| Rice | 48 | ||
| Pasta | 49 | ||
| Pizza | 49 | ||
| Fruit and berries | 49 | ||
| Vegetables | 49 | ||
| Milk | 50 | ||
| Meat and fish | 50 | ||
| Salt | 50 | ||
| Herbs and spices | 51 | ||
| Mealtimes | 51 | ||
| ‘Special’ foods | 51 | ||
| Branded ‘diabetic’ food? | 51 | ||
| ‘Fast food’ | 51 | ||
| Vegetarian and vegan diets | 51 | ||
| Party-time | 52 | ||
| Religious fasting days | 52 | ||
| Ramadan: the fasting month | 52 | ||
| Sweeteners | 52 | ||
| Free from sugar? | 53 | ||
| Intense sweeteners | 53 | ||
| Sweeteners without energy | 54 | ||
| Nutritive sweeteners | 54 | ||
| Fructose | 54 | ||
| Polyols | 55 | ||
| 9. Weight control | 56 | ||
| What is ‘overweight’? | 56 | ||
| Is weight always a problem? | 56 | ||
| Metabolic syndrome | 57 | ||
| Definition of central obesity | 57 | ||
| Acanthosis nigricans | 58 | ||
| Fatty change in the liver | 58 | ||
| Polycystic ovary syndrome (PCOS) | 58 | ||
| Weight loss: the benefits to your health | 58 | ||
| Exercise and weight loss | 59 | ||
| Are low carbohydrate diets useful? | 59 | ||
| Are conventional low fat diets useful? | 59 | ||
| Partial meal replacement diets | 60 | ||
| Using the glycaemic index (GI) in dietary planning for weight reduction | 60 | ||
| Group therapy | 60 | ||
| Drugs for weight loss | 61 | ||
| Sibutramine (Reductil) | 61 | ||
| Rimonabant (Acomplia) | 61 | ||
| Orlistat (Xenical) | 61 | ||
| Weight loss: summary points | 61 | ||
| Bariatric surgery | 62 | ||
| 10. Exercise | 63 | ||
| What happens during exercise? | 63 | ||
| The effects of exercise on the blood level in people treated with insulin | 63 | ||
| Planning and maintaining exercise | 64 | ||
| Exercise and mood | 65 | ||
| Ways of introducing exercise into your daily life | 65 | ||
| Exercise and insulin resistance | 65 | ||
| Benefits of exercise: Research findings | 66 | ||
| Exercise and its effects on blood sugar | 66 | ||
| Exercise and muscle strength | 66 | ||
| Buy a pedometer | 67 | ||
| Classification of pedometerdetermined physical activity in healthy adults | 67 | ||
| 11. Monitoring | 68 | ||
| The blood glucose testing dilemma | 68 | ||
| NICE Guidelines for blood glucose monitoring | 70 | ||
| Do you need to monitor at all? | 70 | ||
| NICE blood glucose guidelines | 70 | ||
| How many tests should you take? | 71 | ||
| If you are on diet and exercise, metformin, gliptin, glitazone or GLP-1 treatment | 71 | ||
| If you are on sulphonylureas | 71 | ||
| Blood Glucose Self-Monitoring Guidelines | 72 | ||
| If you are on insulin | 74 | ||
| Acting on the results | 74 | ||
| Persistently high or low readings | 74 | ||
| Isolated high or low readings | 74 | ||
| Are some things forbidden? | 74 | ||
| Urine tests | 75 | ||
| How to take blood tests | 75 | ||
| Lancets for blood glucose tests | 75 | ||
| Does continuous finger-pricking cause loss of feeling? | 76 | ||
| Why take blood tests? | 76 | ||
| Sources of error when measuring blood glucose | 76 | ||
| Borrowing someone else’s finger-pricking device | 76 | ||
| Alternative site testing | 77 | ||
| Does the meter show the correct value? | 77 | ||
| Which meter? | 77 | ||
| Self-monitoring around mealtimes | 78 | ||
| Self-monitoring around mealtimes if you are not taking insulin | 78 | ||
| Self-monitoring around mealtimes if you are taking insulin | 78 | ||
| Self-monitoring around mealtimes: what it means for you | 79 | ||
| Continuous glucose monitoring | 79 | ||
| Ketones | 79 | ||
| 12. Glycosylated haemoglobin (HbA1c) | 81 | ||
| HbA1c | 81 | ||
| New way of expressing HbAk | 81 | ||
| What level should HbAk be? | 82 | ||
| Relationship between HbA1c and blood glucose | 82 | ||
| Why check your HbAk? | 83 | ||
| For how long do blood glucose levels affect HbA1c? | 83 | ||
| HbA1c goals in Type 2 diabetes | 83 | ||
| How often should you check your HbA1c? | 84 | ||
| Can your HbA1c be ‘too good’? | 84 | ||
| Can the HbA1c measurement give false information? | 85 | ||
| Fructosamine | 85 | ||
| People with an abnormal haemoglobin | 85 | ||
| 13. Tablets for lowering blood sugar | 86 | ||
| Nine Key Points that you need to know when starting an oral treatment for Type 2 diabetes | 86 | ||
| Tablet treatments for diabetes | 87 | ||
| Biguanides (metformin) | 87 | ||
| When should you not use metformin? | 87 | ||
| Available metformin preparations | 88 | ||
| Who should not take metformin? | 89 | ||
| Side effects | 89 | ||
| Evidence for using metformin to manage your diabetes | 89 | ||
| Other uses for metformin | 89 | ||
| Sulphonylureas | 89 | ||
| When should you take a sulphonylurea, and how much? | 90 | ||
| Commonly used sulphonylureas in the UK | 91 | ||
| When should you not use a sulphonylurea? | 91 | ||
| Who should not take sulphonylureas? | 91 | ||
| Side effects | 91 | ||
| Evidence for using a sulphonylurea to manage your diabetes | 92 | ||
| Gliptins | 92 | ||
| When should you not use a gliptin | 92 | ||
| Who should not take gliptins? | 92 | ||
| Side effects | 93 | ||
| Evidence for using a gliptin to manage your diabetes | 93 | ||
| Glitazones (insulin sensitizers) | 93 | ||
| When should you not use a glitazone? | 93 | ||
| Who should not take glitazones? | 94 | ||
| Side effects | 94 | ||
| Pioglitazone | 94 | ||
| Evidence for using glitazones to manage your diabetes | 95 | ||
| Postprandial glucose regulators (PPGRs) | 95 | ||
| When should you avoid PPGRs? | 95 | ||
| Side effects of PPGRs | 96 | ||
| Who should not take PPGRs? | 96 | ||
| Evidence for using a PPGR to manage your diabetes | 96 | ||
| Alpha-glucosidase inhibitors | 96 | ||
| Who should avoid taking acarbose? | 96 | ||
| Side effects of acarbose | 96 | ||
| What is the evidence for using acarbose to treat Type 2 diabetes? | 97 | ||
| Sodium-glucose transporter-2 (SGLT-2) inhibitors | 97 | ||
| GLP-1 agonists | 97 | ||
| Exenatide | 98 | ||
| Liraglutide | 100 | ||
| Once weekly exenatide | 100 | ||
| Oral treatment pathways for blood glucose: what is the best form of treatment? | 100 | ||
| GLP-1 agonists alpha-glucosidase inhibitors | 100 | ||
| 14. Insulin treatment | 103 | ||
| Animal, human and analogue insulin | 103 | ||
| Production of human insulin: biosynthetic DNA-technology method | 103 | ||
| Methods of slowing the action of insulin | 104 | ||
| Units and insulin concentrations | 104 | ||
| Shortand rapid-acting insulin | 104 | ||
| Basal insulin | 105 | ||
| New basal insulins | 105 | ||
| Research findings: Levemir | 107 | ||
| Research findings: Lantus | 107 | ||
| Pre-mixed insulin | 107 | ||
| Twice-daily treatment | 108 | ||
| Multiple injection treatment | 108 | ||
| Research findings: multiple injections | 108 | ||
| Injections before meals (bolus insulin) | 108 | ||
| When should you take your pre-meal dose? | 109 | ||
| Can regular short-acting insulin injections be taken just before a meal? | 109 | ||
| Timing your injections | 109 | ||
| What do I do if my premeal blood glucose is high or low? | 109 | ||
| Can I skip a meal? | 110 | ||
| Bedtime insulin | 111 | ||
| When should the long-acting injection be taken? | 111 | ||
| Mixing insulins | 111 | ||
| Depot effect | 111 | ||
| How accurate is your insulin dose? | 112 | ||
| Insulin absorption | 112 | ||
| Factors influencing the insulin effect | 113 | ||
| What if you forget to take your insulin? | 113 | ||
| Forgotten pre-meal injection (multiple injection treatment) | 113 | ||
| Forgotten bedtime injection (multiple injection treatment) | 114 | ||
| What if you take the wrong type of insulin? | 114 | ||
| At bedtime | 114 | ||
| During the day | 115 | ||
| Having a lie-in at weekends | 115 | ||
| Staying awake all night | 115 | ||
| Shift work | 115 | ||
| Safe use of insulin and insulin passports | 116 | ||
| 15. Administering insulin | 117 | ||
| Injection technique | 117 | ||
| Taking the pain out of injections | 117 | ||
| Research findings: injection technique | 118 | ||
| Is it best to inject into fat or into muscle? | 118 | ||
| Recommended injection sites | 118 | ||
| In the tummy or the thigh? | 119 | ||
| Is it necessary to disinfect the skin? | 119 | ||
| Storage of insulin | 120 | ||
| Syringes | 120 | ||
| Injections with syringes | 120 | ||
| Pen injectors | 121 | ||
| Replacing pen needles | 121 | ||
| Different pens for daytime and nighttime insulin | 122 | ||
| Air in the cartridge or syringe | 123 | ||
| How to get rid of the air in the insulin cartridge | 123 | ||
| Insulin on the pen needle | 124 | ||
| Used needles and syringes | 124 | ||
| Insulin pumps | 124 | ||
| What is an insulin pump, and should you use one in Type 2 diabetes? | 125 | ||
| What do the studies say about using pumps in Type 2 diabetes? | 125 | ||
| What’s the conclusion? | 125 | ||
| New methods of insulin delivery | 126 | ||
| Inhaled insulin | 126 | ||
| Nasal insulin | 126 | ||
| 16. Changing insulin requirements | 127 | ||
| Moving on to insulin | 127 | ||
| Combination therapy – basal insulin combined with other treatments | 128 | ||
| Insulin and metformin | 128 | ||
| Insulin and other tablets | 128 | ||
| Insulin and GLP-1 agonists | 128 | ||
| Treatment with insulin alone | 129 | ||
| Pre-mixed insulin | 129 | ||
| Splitting the evening dose of mixed insulin | 129 | ||
| Why do blood glucose results vary from day to day? | 130 | ||
| Food intake | 131 | ||
| Skin temperature | 131 | ||
| Exercise | 132 | ||
| Depth of insulin injection | 132 | ||
| Site of injection | 132 | ||
| Illness | 132 | ||
| Stress | 132 | ||
| Blood glucose goals | 133 | ||
| Managing your insulin doses | 133 | ||
| Keeping good records | 133 | ||
| What to do if your blood glucose level is high | 133 | ||
| 17. Side effects and problems with insulin | 135 | ||
| Key concerns people have about insulin treatment | 135 | ||
| Insulin and weight gain | 135 | ||
| Does insulin increase appetite? | 136 | ||
| Hypoglycaemia | 137 | ||
| Why do patients with Type 2 diabetes have to take such large amounts of insulin? | 138 | ||
| Insulin resistance syndrome | 138 | ||
| Reducing the insulin dose | 138 | ||
| Problems at the injection sites | 138 | ||
| Lipohypertrophy | 138 | ||
| Redness at injection sites | 139 | ||
| Stinging after insulin injections | 139 | ||
| Bruising after insulin injections | 139 | ||
| Insulin antibodies | 140 | ||
| 18. Hypoglycaemia | 141 | ||
| Stages of hypoglycaemia | 142 | ||
| Blood glucose levels and symptoms of hypoglycaemia | 143 | ||
| Symptoms of hypoglycaemia related to adrenaline production | 144 | ||
| Symptoms of hypoglycaemia from the brain | 144 | ||
| Research findings: effects of low blood glucose | 145 | ||
| Severe hypoglycaemia | 145 | ||
| What caused your hypoglycaemia? | 145 | ||
| Seizures | 146 | ||
| Hypoglycaemia unawareness | 146 | ||
| Driving and insulin | 147 | ||
| Tips for safe driving | 147 | ||
| Rebound phenomenon | 148 | ||
| Too little food or too much insulin? | 148 | ||
| Night-time hypoglycaemia | 148 | ||
| Symptoms indicating night-time hypoglycaemia | 149 | ||
| Taking the wrong type of insulin | 149 | ||
| Can you die from hypoglycaemia? | 149 | ||
| 19. Treating hypoglycaemia | 150 | ||
| Which dose of insulin contributed to your hypoglycaemia? | 150 | ||
| Practical instructions | 150 | ||
| Treatment of hypoglycaemia (as recommended by the DAFNE study) | 151 | ||
| How many glucose tablets are needed to treat hypoglycaemia? | 151 | ||
| Timing and hypoglycaemia | 152 | ||
| Hypoglycaemia just before you eat | 152 | ||
| Hypoglycaemia 45–60 minutes before your next meal | 152 | ||
| Hypoglycaemia 1–2 hours before your next meal | 152 | ||
| Helping someone with diabetes who is not feeling well | 152 | ||
| Glucose | 153 | ||
| Should you always eat when you feel hypoglycaemic? | 154 | ||
| Fructose | 154 | ||
| After hypoglycaemia | 155 | ||
| Research findings: recovery from hypoglycaemia | 155 | ||
| Learning to recognize the symptoms of hypoglycaemia | 156 | ||
| 20. Stress | 157 | ||
| Stress in daily life | 158 | ||
| Stress | 159 | ||
| Research findings: stress and HbA1c | 159 | ||
| 21: Coping with sickness | 161 | ||
| What to do if your blood glucose is high | 161 | ||
| Illness and need for insulin | 162 | ||
| Nausea and vomiting | 162 | ||
| Insulin treatment while you are ill (excluding gastroenteritis) | 163 | ||
| Gastroenteritis | 163 | ||
| How do different illnesses affect blood glucose? | 164 | ||
| The signs that tell you when to go to hospital | 164 | ||
| Wound healing | 164 | ||
| Surgery | 165 | ||
| Drugs that affect blood glucose | 165 | ||
| Teeth | 166 | ||
| Gingivitis | 166 | ||
| Having a tooth out | 166 | ||
| Vaccinations | 167 | ||
| 22. Type 2 diabetes and younger people | 168 | ||
| Why me? | 168 | ||
| Type 2 diabetes and lifestyle | 170 | ||
| Are the symptoms any different in younger people? | 170 | ||
| What can be done? | 170 | ||
| Is treatment with insulin inevitable in time? | 171 | ||
| What does the future hold? | 171 | ||
| Type 2 diabetes in young people who are not overweight | 172 | ||
| Finding out more | 173 | ||
| Useful resources if you are a young person with Type 2 diabetes, or the parent of a young person with Type 2 diabetes | 173 | ||
| 23. Smoking | 174 | ||
| The risks | 174 | ||
| How do I stop? | 175 | ||
| Willpower | 175 | ||
| Counselling services | 175 | ||
| Complementary therapies | 175 | ||
| Nicotine replacement therapy | 175 | ||
| Buproprion | 176 | ||
| Passive smoking | 177 | ||
| Snuff | 177 | ||
| 24. Alcohol and other substances | 178 | ||
| Alcohol and the liver | 178 | ||
| Why is it dangerous to drink too much if you have diabetes? | 178 | ||
| Basic rules for people taking insulin | 179 | ||
| Units of alcohol | 180 | ||
| Dieting and weight loss | 181 | ||
| Illegal drugs | 181 | ||
| Benzodiazepines | 181 | ||
| Cannabis | 182 | ||
| 25. Sexual problems and Type 2 diabetes | 183 | ||
| Problems with your erection | 183 | ||
| Depression | 183 | ||
| Adequate investigation of any medical problems | 184 | ||
| Medical treatment of erectile dysfunction | 184 | ||
| Tablets | 185 | ||
| Local agents | 185 | ||
| Mechanical devices | 185 | ||
| What happens if nothing works? | 185 | ||
| What about women? | 185 | ||
| Menstruation | 186 | ||
| Fertility | 187 | ||
| Contraception | 187 | ||
| The Pill | 187 | ||
| Intrauterine devices and implants | 187 | ||
| Contraceptive methods | 188 | ||
| Staying healthy | 188 | ||
| 26. Pregnancy and diabetes | 190 | ||
| Preparing for pregnancy | 190 | ||
| Glucose Control | 191 | ||
| Research findings: diabetes and pregnancy | 191 | ||
| Blood pressure control | 192 | ||
| Cholesterol | 192 | ||
| During the pregnancy | 192 | ||
| Gestational diabetes | 192 | ||
| Delivery | 193 | ||
| Feeding your baby | 193 | ||
| 27. Social and employment issues | 195 | ||
| Social life | 195 | ||
| Eating out | 195 | ||
| Diabetes ID | 196 | ||
| Being a parent with diabetes | 197 | ||
| Adoption | 197 | ||
| Diabetes and work | 197 | ||
| The Disability Discrimination Act | 198 | ||
| Fitness for employment | 199 | ||
| Telling your colleagues | 199 | ||
| Discrimination, and what to do about it | 200 | ||
| Shift work | 200 | ||
| Guidelines for safe shift-working for people on insulin | 200 | ||
| Diabetes and the Armed Forces | 201 | ||
| Driving and diabetes | 201 | ||
| To consider while driving | 202 | ||
| 28. Travelling with diabetes | 204 | ||
| Travelling with insulin | 204 | ||
| Names of insulin abroad | 205 | ||
| Passing through time zones when on insulin | 206 | ||
| Multiple injection treatment | 206 | ||
| Two-dose treatment | 207 | ||
| Safety rules for flying within the US | 207 | ||
| Vaccinations | 207 | ||
| Ill while abroad? | 207 | ||
| Diarrhoea | 208 | ||
| Problems with travel sickness? | 208 | ||
| Extra documentation | 208 | ||
| Diabetes equipment you may need on the trip | 209 | ||
| 29. Psychological aspects of Type 2 diabetes | 210 | ||
| Common responses to the diagnosis of Type 2 diabetes | 210 | ||
| Need for information | 211 | ||
| Psychological support | 211 | ||
| Handling the diagnosis of diabetes: what your health professional should do | 212 | ||
| Group/peer support | 212 | ||
| Support from partners and other family members | 212 | ||
| Anxiety and Type 2 diabetes | 212 | ||
| Research findings: anxiety and Type 2 diabetes | 213 | ||
| Depression and Type 2 diabetes | 214 | ||
| Issues to come to terms with following a diagnosis of diabetes | 214 | ||
| Diabetes and underlying psychiatric illness | 214 | ||
| Schizophrenia | 214 | ||
| Research findings: depression and Type 2 diabetes | 215 | ||
| Diabetes and severe psychosis | 215 | ||
| Type 2 diabetes and eating disorders | 216 | ||
| Can psychological interventions help? | 216 | ||
| Taking control | 216 | ||
| 30. Complications of the cardiovascular system | 217 | ||
| What are macrovascular complications? | 217 | ||
| Blood glucose levels | 217 | ||
| What is the evidence for a link between high blood glucose and macrovascular complications? | 217 | ||
| 31. Microvascular complications | 222 | ||
| Complications affecting the eyes (retinopathy) | 222 | ||
| Treatment | 223 | ||
| Disturbed vision at unstable blood glucose levels | 224 | ||
| Glasses | 224 | ||
| Contact lenses | 224 | ||
| Complications affecting the kidneys (nephropathy) | 224 | ||
| Stages of kidney damage | 225 | ||
| Complications affecting the nerves (neuropathy) | 226 | ||
| Treatment: loss of sensation | 227 | ||
| Treatment: pain due to nerve damage | 227 | ||
| The autonomic nervous system | 227 | ||
| Problems with the autonomic nervous system | 228 | ||
| Avoiding complications: the evidence | 228 | ||
| 32. Problems with feet | 230 | ||
| Why do foot problems happen? | 230 | ||
| Minimizing the risk of foot problems | 231 | ||
| The major complications of diabetes causing foot problems | 231 | ||
| Treating foot ulcers | 232 | ||
| FOOT CARE RULES Dos | 232 | ||
| FOOT CARE RULES Don’ts | 233 | ||
| Looking after your feet: first aid measures | 234 | ||
| Charcot foot | 234 | ||
| 33. Associated diseases | 236 | ||
| Insulin resistance | 236 | ||
| Features of the metabolic syndrome | 236 | ||
| Problems associated with insulin resistance | 237 | ||
| Polycystic ovarian syndrome (PCOS) | 237 | ||
| Non-alcoholic steatohepatitis (NASH) | 237 | ||
| Acanthosis nigricans | 238 | ||
| Maturity onset diabetes of the young (MODY) | 238 | ||
| Causes of secondary diabetes | 238 | ||
| Hormonal causes | 238 | ||
| Cushing’s syndrome | 238 | ||
| Acromegaly | 238 | ||
| Pancreatic disease and pancreatitis | 238 | ||
| Haemachromatosis | 239 | ||
| 34. Type 2 diabetes in later life | 240 | ||
| Best possible blood glucose levels | 240 | ||
| Glucose-lowering drugs: which is best for you? | 241 | ||
| Metformin | 241 | ||
| Sulphonylureas | 241 | ||
| Gliptins and GLP-1 analogues | 241 | ||
| Pioglitazone | 242 | ||
| Insulins | 242 | ||
| Management of other risk factors if you are older | 243 | ||
| Aspirin therapy | 243 | ||
| Blood pressure control | 243 | ||
| Reducing cholesterol in older adults | 243 | ||
| Management of erectile dysfunction if you’re older | 244 | ||
| Diabetes foot care | 244 | ||
| Diabetes in a care home | 244 | ||
| General rules | 245 | ||
| 35. Support and information | 246 | ||
| What care should you be getting from your primary care team? | 246 | ||
| Finding help from other sources | 247 | ||
| Diabetes UK | 247 | ||
| Publications | 248 | ||
| Living with diabetes | 248 | ||
| Diabetes UK holidays | 248 | ||
| Diabetes UK family weekends | 248 | ||
| Local Diabetes UK groups (previously called branches) | 248 | ||
| Parent support groups | 249 | ||
| Insurance | 249 | ||
| Joining Diabetes UK | 249 | ||
| Other useful organizations | 249 | ||
| Institute of Diabetes for Older People (IDOP) | 249 | ||
| International Society for Pediatric and Adolescent Diabetes | 250 | ||
| Juvenile Diabetes Research Foundation (JDRF) | 250 | ||
| International Diabetes Federation (IDF) | 250 | ||
| Diabetes Ireland | 250 | ||
| British Heart Foundation | 251 | ||
| National Kidney Federation (NKF) | 251 | ||
| RNIB | 252 | ||
| The Stroke Association | 252 | ||
| Practical and financial support | 252 | ||
| Claiming benefits | 252 | ||
| Prescription advice | 253 | ||
| Reimbursed accessories | 254 | ||
| Diabetes and the internet | 254 | ||
| Using the Internet | 255 | ||
| 36. Outcome studies in Type 2 diabetes | 256 | ||
| What is an ‘outcome study’? | 256 | ||
| Outcome studies looking at the effect of controlling blood glucose | 256 | ||
| UKPDS | 256 | ||
| What did it show? | 257 | ||
| What does the UKPDS tell us? | 257 | ||
| Ten year follow-up of survivors of the UKPDS | 257 | ||
| What does the UKPDS follow-up study tell us? | 257 | ||
| Two contrasting studies published in 2008 | 257 | ||
| What did these two studies tell us? | 258 | ||
| Effects of the ACCORD study | 258 | ||
| Veterans Diabetes Trial | 258 | ||
| Conclusions from all blood glucose studies | 259 | ||
| Outcome studies looking at control of blood pressure | 259 | ||
| UKPDS | 259 | ||
| UKPDS 30-year follow-up study | 259 | ||
| ADVANCE BP | 259 | ||
| ACCORD-BP | 259 | ||
| Swedish National Register blood pressure study | 260 | ||
| HOPE | 260 | ||
| What did it show? | 260 | ||
| What does this mean? | 260 | ||
| ASCOT | 260 | ||
| 37. Research and new developments | 264 | ||
| No new drugs | 264 | ||
| Very strict food restriction cures diabetes | 264 | ||
| Other research | 264 | ||
| Looking ahead | 265 | ||
| Glossary | 266 | ||
| Finding our more | 274 | ||
| Index | 275 |