Understanding Diabetes - Q4 - Nov 2018

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NOVEMBER 2018 HEALTHAWARENESS.CO.UK

Understanding Diabetes

“The ultimate goal would be to live in a world where diabetes can do no harm. Until that day, we need to keep up the awareness” Lee from Steps P8 Read celebrity 'This Morning' chef Phil Vickery's sugar-free Five Spice Meringue recipe Phil Vickery P6 CREDIT: JAMIE GARBUTTDIABETES UK

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IN THIS ISSUE

Rugby player Chris Pennell Talks about how flash glucose monitoring changed his life P4

15 Healthcare essentials How you can take control of your lifestyle to reduce your risk of developing diabetes ONLINE

Diabetic foot ulcers And the importance of early diagnosis P10

We all have a part to play in the fight against diabetes Diabetes does not just affect individuals – it has an impact on entire families. It is fair to suggest that most of us know somebody living with diabetes. Today, the disease represents a concern for every family – from the parents of a child with type 1 diabetes, to people caring for an adult family member with diabetes complications, and those with a family member at risk of type 2 diabetes.

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ith the rising healthcare and societal costs associated with diabetes – USD727 billion in direct medical costs alone in 2017 – we must think about how the increasing prevalence can be tackled and the related complications prevented. It is an ambition that will require a wholeof-society approach.

If healthcare professionals are able to establish earlier diagnoses, we can ensure that the person with Follow us

diabetes receives the treatment they need more urgently to prevent the potentially devastating complications associated with the disease. Diabetes is a leading cause of blindness, heart disease, stroke, kidney disease and lower limb amputation.

If untreated, type 1 diabetes is a death sentence Of the estimated 425 million people currently living with diabetes, around 10% have type 1 diabetes.

This type of diabetes has to be treated with insulin. At present, there is no way to prevent type 1 diabetes. If untreated, the diagnosis of type 1 diabetes is a death sentence.

Type 2 can often be treated through diet and exercise This leaves around 90% with type 2 diabetes. In many cases – up to 80% according to some figures – type 2 diabetes can be prevented through regular physical activity and healthy eating habits.

Unfortunately, type 2 diabetes often flies under the radar. Onset can MediaplanetUK

be slow and the warning signs and symptoms not obvious. In fact, one in two of all people currently living with diabetes remain undiagnosed.

Professor Nam H Cho President, International Diabetes Federation

Diabetes is a leading cause of blindness, heart disease, stroke, kidney disease and lower limb amputation @MediaplanetUK

Governments must promote healthy lifestyle initiatives We all have a role to play but governments need to do more to help us protect family members from developing type 2 diabetes and its life-threatening complications.

Governments must ensure people with all types of diabetes have access to the medicines and care they require. Families expect more. Our recent global research shows that only one in five (17%) people believe their government is doing enough to tackle diabetes.

Governments can help stop the rise in type 2 diabetes by focusing on education initiatives and establishing polices that support an improved lifestyle and dietary choices. They need to help identify people who are not yet diagnosed, and those at high-risk, so the medical community can intervene early before people are @MediaplanetUK

left needing treatment for diabetes complications.

Habits formed in teenage years can have long-lasting consequences It is critical that we educate children and young adults about the behaviours that can lead to type 2 diabetes. More than two thirds (70%) of premature deaths in adults are often the result of behaviour that began during adolescence.

We therefore need to influence the adoption of habits that facilitate prevention and create environments that encourage health. We must work with parents to help them provide their children with a blueprint for a healthy future.

There’s work to be done. But if governments, healthcare organisations and families across the globe take action now, we will be in a better position to discover, manage and prevent diabetes for future generations.

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500,000 people with diabetes are undiagnosed The NHS is facing a type 2 diabetes epidemic. Huge amounts of NHS money and time could be saved if more focus was given to better detection, lifestyle management and appropriate use of medication.

Dr Stephen Lawrence Principal Clinical Teaching Fellow, Warwick Medical School, University of Warwick Of the 66 million people in the UK, around 3.7 million have been diagnosed with diabetes. “That's a significant proportion of the population, but it's just the tip of the iceberg,” warns Dr Stephen Lawrence, Principal Clinical Teaching Fellow, Warwick Medical School, University of Warwick.

“There are also an estimated 500,000 people who are yet to be diagnosed.”

Plainly, diabetes is a medical epidemic, but the current stresses on the National Health Service are welldocumented. Is it able to cope with the increasing numbers diagnosed with the disease?

80% of NHS money on diabetes could be saved “Around 10% of the NHS budget is spent on diabetes treatment,” says Dr Lawrence. “That's approximately £10 billion — or about £1 million an hour. The sobering thing is that 80%

of the money we spend on diabetes care and treatment is driven by potentially avoidable complications.

If we were to improve detection, lifestyle management and appropriate use of medication we could make a significant impact on that enormous cost. Yet, despite pressure on the system, good outcomes regarding diabetes care are achieved in this country.”

Innovative and revolutionary medications Today's treatment has certainly revolutionised lives. “We now have

medication that helps control glucose, blood pressure and promotes weight loss,” says Dr Lawrence. “We also have ultra-long-acting insulins that are injected once a day and offer the confidence of good control without hypoglycaemic episode risk. Pharmaceutical companies are really listening to the needs of patients and their prescribers.”

Gut microbiota could contribute to diabetes Lawrence has a “wish list” for further medical breakthroughs. For example, interesting studies are

underway to investigate the association between gut microbiota, obesity and diabetes. He would also like to see an improvement in medication delivery. “Some people with diabetes have to take in excess of six tablets a day,” he says. “So I think the future is a polypill: one tablet that combines all the necessary baseline medication needed to control diabetes. This would reduce tablet burden — and improve adherence to treatment.”

Tony Greenway

What’s changed in diabetes since the 60s?

In the 1960s and 1970s, people with diabetes were offered limited and unpersonalised treatment. Thankfully, it's a different story today, says one leading clinician.

Professor Roger Gadsby MBE Honorary Associate Clinical Professor Warwick Medical School, University of Warwick When Professor Roger Gadsby began his medical career around 40 years ago, the care and treatment for type 2 diabetes was very different. But then, far fewer people had been diagnosed with the disease.

“At that time, approximately 1%-1.5% of the country had a type 2 diabetes diagnosis, so it was a relatively rare

condition,” says Gadsby, Honorary Associate Clinical Professor, Warwick Medical School, University of Warwick. “Today, those numbers have quadrupled. I'm afraid the prevalence of type 2 diabetes mirrors people's increasing obesity and sedentary nature.”

Increased treatment options In the 1960s and 1970s, most diabetes care took place in hospital.

Now, around 90% of people with type 2 diabetes are able to receive care in the community, which causes less disruption to their lives. Forms of treatment were less varied then, too. “By the mid-

The increase of type 2 diabetes mirrors increasingly sedentary lifestyles 1980s, patients had just three types of treatment options: insulin and two kinds of glucose-lowering tablets,” notes Professor Gadsby. “That meant it was difficult to personalise care or reduce complications if they arose.” Now, it's a different story: there are more than six kinds of medication available in tablet and injectable form.

Driving up standards Another change has been the medical profession's view of the disease.

“Clinicians used to look at diabetes in a strictly medical way,” remembers Professor Gadsby. “Now, there's an attempt to motivate people to make dramatic changes to their lifestyles that will either prevent diabetes — or, if they already have it, send it into remission.”

Initiatives such as the National Diabetes Audit — which measures the quality of diabetes care in England and Wales — and the Quality and Outcomes Framework (QOF), have undoubtedly helped improve patient care. Education has also developed to meet the needs of

clinicians. “The tools are there to enable practices to run good diabetes care,” says Professor Gadsby. “I'm optimistic that patient treatment will improve further, but only if financial and human resources continue to be made available.”

Tony Greenway Read more at

warwick.ac.uk/diabetes

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Flash glucose monitor puts finger-prick testing in the past Worcester Warriors rugby player Chris Pennell rememberss how w he used to check his glucose levels with a finger-prick test — and says how much easier life is with a flash monitor.

Professional rugby player, Chris Pennell, was 19 years old when he was diagnosed with diabetes.

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t the time, he was understandably worried about how it might affect his career. “In my second year as a professional I had a pre-season blood test that showed my blood glucose was abnormally high,” he says.

“After further tests, the club doctor confirmed that I had type 1 diabetes.

Luckily, I had a very reassuring conversation with him, which put my mind at ease. He stressed that it wouldn't stop me from doing what I wanted to do — which was to continue to be a professional rugby player.”

I was pricking my finger up to 20 times a day Even so, Chris — a fullback with Premiership team, Worcester Warriors — knew he would have to manage his diabetes properly. That meant injecting with insulin and regularly checking his glucose levels with fingerprick tests.

“Early on, I was pricking holes in my fingers 10 to 20 times a day,” he remembers. “The frustrating thing

about finger-prick testing is that it only tells you what your level is at that particular time. It doesn't give you an indication of what it was, or where it might be going.”

I was able to check my levels with my phone Now, however, Chris has a flash glucose monitor which, he says, “changed my life in a short period of time.” Essentially, a sensor is implanted in the back of his arm which he scans with either his phone or a reader to check his level. He replaces the sensor himself every two weeks. “Flash monitoring allows me to test more regularly and see where my level could be heading,” he says.

“It's made a huge difference to me.”

The monitor alerted me to my nighttime hypoglycaemia For example, Chris has always taken pride in his diabetes management and was under the impression that his control was excellent. “I used to take a finger-prick test before I went to sleep and another when I woke up, and the numbers were always fine, so I assumed my glucose levels were normal during the night,” he says. “But when I hooked up to a

flash system it showed I was actually dropping intoo hypoglycaemia two or three times while I was asleep. Had it not been for the monitor, I'd never have known about it.”

Chris has now been able to make positive and proactive changes to his management regime to stop his night-time hypos.

This tech has been revolutionary for me “I'm fortunate,” he says. “I have excellent diabetes controll — yet the monitor had a big impact on me. So, for people who don't havee my level heir world. of control, it will change their Can you imagine thee peace of mind it would give to a parent who d's levels can check their child's throughout the night by simply d scanning going into their room and hile they're the back of their arm while asleep? As technology, it's been beyond beneficial.”

Tony Greenway IMAGE: JMPUK

Chris Pennell Fullback, Worcester Warriors

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There is a lack of access to technological treatments for diabetes in the NHS Smart technologies are now available to help people with diabetes take control of their diabetes and improve their quality of life. However, due to unexplained reasons, the availability of these technologies to people who genuinely deserve access remains low.

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here is a postcode lottery, which is unfair and unjust.

Action is urgently needed to ensure access is universally available to get rid of the postcode lottery that exists in the NHS today.

On 13th September last year, it was announced that flash glucose monitoring will be made available on the NHS. Flash glucose monitoring can free people living with diabetes from the pain and rigour of frequent finger-prick testing and put them in greater control of their condition. In doing so, it has the potential to help prevent a host of devastating longterm complications.

However, more than a year has passed since the announcement, and I ask, ‘What progress has been made?’ While several clinical commissioning groups have made this technology available to their patients, many others have dragged their feet, resulting in a postcode lottery system in England. Just

across the border, in Scotland, the situation is entirely different, where a decision to fund this centrally means that this technology is being made available freely.

20 years of blood glucose monitoring means pricking your finger 20,000 times A person with diabetes, who is treated with insulin injections, has to monitor their blood glucose on a daily basis minimum of four times a day. They will, on average, prick their fingers more than 20,000 thousand times if they have had diabetes for 20 years.

Double that if you have diabetes for 40 years and you like to check your blood sugars more than four times a day.

This is why many people with diabetes struggle and at times disengage from self-care, which is the most important way to take control of their lives.

Since the announcement about flash glucose monitoring by the NHS in September this year, local access was left to those who commission diabetes service. What has followed is chaos, confusion, frustration and bewilderment among people with diabetes as to why they are being denied this life-changing technology. Is it just about the resources or a lack of understanding among local decision makers about the impact of this technology on quality of life of people with

Dr Dinesh Nagi MBBS PhD FRCP Consultant in Diabetes and Endocrinology MYT, and Chairman of Association of British Clinical Diabetologists

Flash glucose monitoring can free people living with diabetes from the pain and rigour of frequent finger-prick testing diabetes or just simply that “they” don’t care? It is time for HCPs to stand up and be counted and fight to ensure flash glucose monitoring is freely available to those people with diabetes.

For several years, we have awaited technological developments that will provide people with diabetes (and healthcare professionals), the essential tools to better understand and manage this chronic condition. One of the most recent of these developments has been the non-invasive glucose monitoring, (Flash Glucose Monitoring FSL and Continuous Glucose Monitoring), which allows freedom from fingerpricks and gives people with diabetes a tool to see if their blood sugars are rising or falling. This amazing technology is still unavailable to many, despite it being recommended by the NHS. What about continuous glucose monitoring (CGM)?

CGM was approved by NICE as an option for monitoring blood glucose continuously, in people with diabetes who have no awareness of warning symptoms when glucose levels fall to dangerously low levels. More recently, technology has allowed the suspension of insulin delivery, at a level of glucose that can be pre-set.

The uptake of this technology also remains low in UK, while NICE estimates that people with type 1 diabetes are potentially eligible.

NICE recommends that we should consider real-time continuous glucose monitoring for adults with type 1 diabetes who are willing to

commit to using it at least 70% of the time and to calibrate it as needed, and who have any of the following despite optimised use of insulin therapy and conventional blood glucose monitoring: • More than one episode a year of severe hypoglycaemia with no obviously preventable precipitating cause • Complete loss of awareness of hypoglycaemia • Frequent (more than two episodes a week) asymptomatic hypoglycaemia that is causing problems with daily activities • Extreme fear of hypoglycaemia • And finally, poor control of diabetes (HbA1c level of 75 mmol/mol [9%] or higher) that persists despite testing at least 10 times a day I hope that raising awareness of these new technologies for people with diabetes can only be a good thing and will improve the current situation, which is far from satisfactory. I would urge all insulin treated patients to ask their specialist or GP if they are eligible or can benefit from these technologies.

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Live healthily to avoid the complications of diabetes Everyone is different, and there’s no one-size-fits-all diet or exercise regime that will work for everyone living with type 2 diabetes. But there are some general tips you can follow to help you manage blood glucose (sugar) levels, blood pressure and cholesterol to reduce your risk of diabetes complications.

Phil Vickery Chef, ITV’s ‘This Morning’

Soft Chinese Five-Spice Meringues

T Douglas Twenefour Deputy Head of Care, Diabetes UK

ENERGY 4kcals, PROTEIN 1g, FAT 0g, SATURATED FAT 0g, CARBOHYDRATE 0g, TOTAL SUGARS 0g, SALT 0g MAKES 8–12 MERINGUES (SERVES 4) / PREP TIME 15 minutes, plus 10 minutes cooling / COOKING TIME 1 hour

Ingredients: 3 egg whites (80g), at room temperature pinch of cream of tartar 75g sweetener 1 tablespoon Chinese five-spice powder (optional) This recipe is very similar in texture and taste to the classic French dessert ‘Floating Islands’. The only difference is that you bake these meringues and rather than poach them in a thin egg custard (or crème anglaise). The end result is a delicious, sugar-free dessert.

he complications of diabetes are potentially life-threatening, and include cardiovascular disease, stroke, sight loss, amputation and kidney diseases. That’s why careful management of diabetes is so important.

If you have type 2 diabetes and are overweight, losing weight can significantly improve your diabetes management. It can help lower your blood glucose levels and reduce your risk of complications. We’ve even seen that substantial weight loss, along

with close clinical support, can put some people’s type 2 diabetes into remission.

Regardless of what type of diabetes you have, or whether you need to lose, gain or maintain your current weight, it’s vital that you make the healthy food choices, and live as active a lifestyle as possible. We’ve produced some tips – available in full on the Diabetes UK website – to help you make healthier food choices.

Read more at

diabetes.org.uk

Diabetes UK’s tips for healthy eating with diabetes:

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Choose healthier carbohydrates: whole grains, fruit, vegetables and pulses

Eat less salt: Try to limit to 6g (one teaspoonful) a day

Eat less red and processed meat: pulses, eggs, fish and poultry are good replacements

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Eat more fruit and veg

Choose healthier fats, such as nuts, seeds, oily fish, and olive, rapeseed or sunflower oil

Cut down on added sugar: low or zerocalorie sweeteners are a better alternative

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Be smart with snacks: think yoghurt, unsalted nuts, seeds, fruit and veg

Drink alcohol sensibly: Try to keep to a maximum of 14 units a week, and spread it out to avoid binge drinking

Get your minerals and vitamins from foods, unless told otherwise by your healthcare team

1. Preheat the oven to 150°C/gas mark 2. Line a large baking tray with baking parchment.

2. Put the egg whites into a clean, grease-free mixing bowl and add the cream of tartar. By hand, just lightly whisk them together until combined, then using an electric whisk, whisk the mixture on a high speed until thick and foamy, about 2–3 minutes. Reduce the speed of the whisk, sprinkle over the sweetener, then increase the speed again and whisk for a further 4–5 minutes until you have a thick and glossy meringue mixture.

3. Using a dessertspoon, place blobs of the meringue onto the lined baking tray to make 8–12 meringues, leaving a little space between each one, then evenly sprinkle a little of the five-spice powder, if using, over each one. Bake for 1 hour, until soft but not sticky to the touch.

4. Remove from the oven and leave to cool for 10 minutes, then carefully transfer the meringues to serving plates (serve two or so meringues per serving).

Phil Vickery, one of the UK’s most popular chefs, has been a resident cook on ITV’sThis Morning for nearly two decades. He has written 18 acclaimed books, including the award-winning Phil Vickery’s Ultimate Diabetes Cookbook, from which these recipes are taken, published by Kyle Books, £19.99.

Check out Phil’s Fruity Ice Cream recipe at

diabetesadvice.co.uk

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ITV’s the Fast Fix: Diabetes programme sent our diabetes into remission Exante Skinny Strawberry Panna Cotta 1. Place gelatine leaves in a bowl, pour over enough cold water to cover the leaves Ingredients: • 1 Exante Meal Replacement Strawberry Shake made with 200ml water • 4 gelatine leaves

and leave to soak for 5 minutes until softened. Remove the gelatine from the water and squeeze away any excess water.

2. Make up the Exante Strawberry Shake as directed on the pack and add to a pan and heat gently. Once simmering, add in the gelatine leaves one at a time and stir until dissolved. Leave to cool.

• 50g strawberries

3. Lightly grease 4 individual metal moulds and divide the mixture between

• 50ml milk

them. Leave in the fridge for at least 6 hours or overnight until set.

• 50ml half fat crème fraiche

4. Once set, remove from the fridge and tap the bottom of the moulds and empty onto serving plates. Serve and enjoy!

Adhering to a strict diet wasn’t easy, but it revolutionised Tracey Ward’s life. After years of health problems, she’s now feeling fit and well, and her diabetes has gone into remission.

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year ago, Tracey Ward was miserable. She had been suffering from health problems for around a decade and her weight was a real cause for concern. Tracey is 5ft 3 and, at her heaviest, was around 16 stone. “I wasn't able to go out,” she says. “Even walking up the stairs was a problem. I wasn't living. I was just existing.”

After being diagnosed with Type 2 diabetes towards the end of 2017, Tracey was invited to take part in ITV's ‘The Fast Fix: Diabetes’ programme, where viewers followed her progress on a strict low-calorie diet. For the eight weeks, her diet consisted of a variety of 200 calorie Exante products – shakes, bars, meals, and soups — and the results were ground breaking. “I always knew what I needed to do, but just didn't have the willpower to do it,” she admits.

My type 2 diabetes was improving day by day Tracey was hesitant about starting the diet, however it changed her life. “I felt like a completely different

Tracey Ward Health and Wellness Blogger/Podcaster/Author person after four weeks,” she says.

“And finger prick tests showed that my diabetes was improving day by

day. Afterwards, I was told I was in remission.” By the end of the eight weeks, Tracey's liver fat had reduced from a massive 22.7% to just 6.6%.

Tracey — an artist by training — has changed her life in more ways than one. She now podcasts, blogs and is the author of life improvement books. Her diet has been completely overhauled and she has now adopted and maintained a low-carb diet which has seen her go from a size 22 to a size 14. The results have been incredibly rewarding both for her health, and in encouraging and motivating other people to do the same.

Tracey is now passionate about dieting, particularly after her success

in controlling and reversing her type 2 diabetes. “You need to stay focused and look at the whole you, rather than just what you eat,” she advises.

“It worked for me. I'm a completely different person, both physically and emotionally.”

Tony Greenway

Exante Delight Chocolate Pops 1. Mix the sachet of Exante Chocolate Delight with 50ml water and mix until Ingredients: • 1 sachet of Exante Chocolate Delight • 25g organic dehydrated coconut • 10g cacao nibs • 25g dark chocolate (80% cacao)

smooth. Place in the freezer for 25 minutes - this will allow you to manage the mix more easily.

2. Divide the mix into 6 and mould into balls, then place onto lollipop sticks.

3. Place the dark chocolate in a bowl over hot water and melt until smooth.

4. Dip the lollipops into the melted chocolate, cover, then dip into the coconut.

5. Place in the freezer for at least two hours, then serve and enjoy!

• 50ml water

When Steve Markham was diagnosed with type 2 diabetes he went on an eight-week, very low-calorie diet of meal replacement shakes. As a result, his disease has gone into remission.

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teve Markham remembers the exact day he was diagnosed with type 2 diabetes: April 1st, 2016. “But it was no joke,” he says. It was a shock because Steve — a data analyst for a water company — wasn't overweight. “I was just under 13 stone,” he says.

“I didn't look overweight, but it turned out that there was a

lot of ectopic fat in my liver and pancreas.”

I’d have four meal replacement shakes a day totalling 800 calories

“My sugar intake was ridiculous”

It was a struggle. But, remembering the image of his liver gave Steve the impetus to keep going. “After two weeks, my blood sugar levels were still in the diabetic range; but after eight weeks I was in the prediabetes stage,” he says. He'd also lost two-and-a-half stone, which meant he needed a new wardrobe. After 12 weeks, tests showed that Steve was in remission from the disease. Since completing the 800 calorie Exante diet, Steve is conscious to maintain his new and improved lifestyle. “I now think about what I eat and when I eat it,” he says. “If I need shakes to get me back on track, I'll have them for a couple of days.”

Looking back, Steve admits his diet had been out of control. “I'd eat slabs of chocolate the size of a front door without thinking about the consequences. As I found out more about type 2 diabetes, I realised how devastating this condition can be.”

After responding to a tweet by celebrity chef, Phil Vickery, about a diabetes cookbook, Steve was approached by a television producer who also invited him to take part in the ITV programme, ‘The Fast Fix: Diabetes’. The programme aimed to see if a diet alone could reverse

Steve Markham Data Analyst

the disease. “The idea was to spend four weeks in a clinic and then four weeks at home on a very low-calorie diet (VLCD),” says Steve.

For anyone thinking about starting a VLCD, Steve advises that you consult your GP and 'go for it'. “Press that reset button and change your eating habits,” says Steve. “I'm now looking forward to the future knowing that I've got my life back on track, and that I control my type 2 diabetes, rather than it controlling me.”

Tony Greenway Read more at

exantediet.com/T2D

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Lee Latchford-Evans Q&A How diabetes has affected me Q: What inspired

you to start raising money/awareness for Diabetes UK?

Q: Being surrounded by people with the diagnoses, what changes have you made in your own life?

A: My grandad had diabetes, my dad was diagnosed with diabetes a few years ago and my mother-in-law had diabetes [all were type 2]. Unfortunately, we lost my dad and mother-in-law this year, not because of diabetes, I may add, but having diabetes didn’t help their situation. I wanted to do something positive to help raise awareness and understanding.

My grandad and dad having both had diabetes increases the chances of me having it, so I am quite mindful of my lifestyle choices - from keeping active to eating a generally healthy diet.

Q: How have you helped in the fight against diabetes?

Q: What is the biggest change you want to see in the fight against diabetes?

A: I have helped raise awareness for Diabetes UK over the years by taking part in the Virgin London Triathlon, The London BUPA 10k, I have ridden from London to Paris, taken on the Prudential Ride 100 race and this year was the face for Diabetes UK’s 1Million Step Challenge. This was a fantastic event as we just asked people to move a little more than they normally would by walking that extra bus stop, a little bit further with the dog, counting your steps when cleaning the house etc.

Each individual had three months to walk one million steps and they could do it however they wanted to. This roughly equates to 11,000 steps a day.

Diabetes UK raised well over £300,000 through this campaign.

A:

A: The ultimate goal would be to live in a world where diabetes can do no harm. Until that day, we need to keep up the awareness.

Q: What advice do you have for people who might be at risk of diabetes?

A: It’s nice to see the facts coming through and the myth’s being broken down, for example: ‘Type 2 is a mild form of diabetes’; there is no such thing.

If not controlled, all forms of diabetes can lead to serious complications.

Another myth: ‘If you have diabetes you can’t have sugar’; that’s not at all true. It’s more that you should follow a healthy, balanced diet that is low in fat, salt and sugar.

Lee Latchford-Evans Singer, Actor, DJ and Ambassador for Diabetes UK Read more at

diabetes.org.uk

Q: How aware of diabetes were you growing up compared to now?

A: In truth, I was not that aware of

diabetes growing up. My dad was diagnosed later on in life and I didn’t have any close friends who had diabetes.

Q: For someone without diabetes, what do you think they might not understand about the condition?

A: From my perspective, (others with families including someone with type 1 diabetes might give a different answer), there is a danger that someone who doesn’t have diabetes might think less about what we are eating. They might not worry about whether blood sugars are too high and they may not understand symptoms of diabetes like going to the bathroom too much, or not always having energy to choose to do what we want to do.

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Why we should take diabetic foot ulcers more seriously According to research, approximately 50% of people with diabetic ulcers will be dead within five years. This shocking statistic shows the importance of foot health.

Professor Paul Chadwick Clinical Director, College of Podiatry and Foot in Diabetes UK. Recognised by the Tissue Viability Society and the Legs Matter Campaign as an expert in the care of the Diabetic Foot.

We have seen a massive increase in the number of people with diabetes in the UK

Diabetic foot ulcers might not carry the same significance as heart attacks or cancer to the public, but the reality is they can be just as deadly.

A patient who suffers with a foot ulceration will face an increased risk of early death that could rise to a mortality rate of 50% within five years.

With this type of ulceration, foot care and prevention really could be limb- and life-saving.

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He explains: “When patients suffer from neuropathy, things like taking a hot bath, wearing ill-fitting shoes or simply walking on an existing ulcer can create – or further exacerbate – foot problems.

“We have seen a massive increase in the number of people with diabetes in the UK, which –coupled an over a 30% drop in podiatry students coming through, which may be linked to the loss of bursary funding – is causing a ticking time-bomb. But if we can increase knowledge of foot care and prevention among those living with diabetes, then we could save lives.”

A ticking time-bomb Professor Paul Chadwick is the Clinical Director, College of Podiatry.

Diabetic foot ulcers are a marker of increased risk of death Diabetic foot ulcers are taken incredibly seriously in the NHS, indeed they are a marker of an increased risk of mortality.

Once a foot ulcer has been seen by a GP or nurse, the 24 hour referral process

or those who are affected, foot ulcers are often the result of another complication of diabetes; a loss of sensation within the feet known as neuropathy.

If you have heard of the saying, ‘God’s greatest gift is pain’, then you can understand that a lack of sensation in the feet and legs can prove problematic.

kicks in which means you should have an appointment to see a podiatrist within 48-hours.

Depending on the level of care needed, you could then be referred to an in-hospital multi-disciplinary team made up of a podiatrist, surgeon and other specialists who aim to heal an uncomplicated ulcer within 12 weeks.

Go straight to your GP, podiatrist or nurse Professor Chadwick supports this approach: “Studies show that once in the hands of a multi-disciplinary team, outcomes are much improved, but timing is everything. It is so important to see your GP or podiatrist straight away, but usually patients ‘don’t want to bother them’, which can really complicate matters down the line.”

Indeed for Professor Chadwick, it is that first line of defence – the podiatrist ¬– that people need to get to as podiatrists can diagnose the right management needed. Whether

that includes antibiotics for infection dressings to manage excess discharge and insoles or devices to reduce pressure when walking, the dressing forms part of a ‘jigsaw approach’ that enables the patient to recover quicker.

Anyone with diabetes is entitled to a foot MOT each year, with their General Practice, who will identify early warning signs and should refer them on to a foot protection team who can help prevent the person developing a foot ulcer Professor Chadwick believes diabetes-related foot ulceration is the ‘Cinderella’ of complications, and the College of Podiatry has joined the Legs Matter movement to help people recognise the early warning signs before they lead to ulceration, amputation, cardiovascular issues and overall, a reduced mortality.

Gina Clarke

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HEALTHAWARENESS.CO.UK 11

Diabetes complications are serious – reduce your risk by taking control High blood sugar levels can seriously damage parts of your body, including your feet and your eyes. These are called the complications of diabetes. But many people living with diabetes don’t know they can reduce their risk of developing them.

I

n a nutshell, diabetes related complications are caused by having high blood sugar levels over an extended period of time.

High blood sugar damages blood vessels and, if they aren’t working

properly, blood can’t reach the parts of the body it needs to.

We know that the higher a person’s HbA1c level, the higher their risk of developing complications. Even a slightly raised HbA1c increases someone’s risk. But it’s not just about blood sugars. High blood pressure, smoking and a lot of fat in your blood (cholesterol) can all damage your blood vessels and put you even more at risk.

Losing your sight – or a limb – to diabetes, or suffering a heart attack, stroke, or kidney disease devastates lives. But with careful management,

and the support of the healthcare team, many of these problems can be delayed – or prevented altogether.

This starts with helping people with diabetes know how to best manage their condition,and supporting them to take the action that will hugely help to reduce their risk of developing complications.

How to prevent or delay complications Stopping smoking and lowering HbA1c levels, blood fats and blood pressure will prevent or slow down diabetes-related complications.

Giving up smoking is one of the best things you can do, because smoking makes it even harder for blood to flow around your body.

Keeping a close eye on these levels and understanding these numbers will help someone with diabetes take control of their health.

To help with this, Diabetes UK have compiled a list of the 15 most important checks a person with diabetes is entitled to – for free – regularly from the NHS. We call these the 15 Healthcare Essentials.

Dan Howarth Head of Care, Diabetes UK Read more at diabetes.org.uk

15 Healthcare essentials Blood glucose test (HbA1c test)

Blood pressure check

Cholesterol check (for blood fats)

Eye screening

Foot and leg check

Kidney tests

Advice on diet

Emotional and psychological support

Diabetes education course

Care from diabetes specialists

Free flu jab

Good care if you’re in hospital

Support with any sexual problems

Help to stop smoking

Specialist care if you’re planning to have a baby

HEALTHAWARENESS.CO.UK Get in touch for the December 2018 edition 07795 022124 leila.samadi@mediaplanet.com uk.info@mediaplanet.com @mediaplanetUK

HEALTHAWARENESS.CO.UK Get in touch for the December 2018 edition 07795 022124 leila.samadi@mediaplanet.com uk.info@mediaplanet.com @mediaplanetUK