Living with diabetes

Question 1

Scale of diabetes

Answer 1

There are around 3.8 million people in the UK with diabetes1.
Of these, 3.2 million have been diagnosed with either Type 1 or Type 2 diabetes. The rest have Type 2 diabetes but don’t know they have it because they haven’t been diagnosed.
Over one in 20 people in the UK has diabetes

Question 2

All people with diabetes are at risk from hypoglycaemia ?

Answer 2

False

Only those on insulin or agents which stimulate endogenous insulin secretion

Question 3

Having type 2 diabetes will affect your driving licence?

Answer 3

Depends on type of licence
Diabetes treatment
Severe hypoglycaemia or hypo unawareness
Presence of visual/neuropathic complications

Question 4

People with type 1 diabetes will have all employment opportunities protected by Equality Act 2010?

Answer 4

True

Blanket bans lifted in emergency services for Type 1 diabetes and Type 2 diabetes who use insulin – individual assessment.
Armed forces exempt from Equality Act 2010 and can enforce a blanket ban on the recruitment of people with diabetes
Some NHS ambulance trust place restrictions on recruitment of people with diabetes

Question 5

Syringes, insulin pens and insulin must be given to the cabin crew on a plane during the flight for safety reasons?

Answer 5

Keep all insulin, injecting and monitoring equipment
With them at all times
Letter from health care professional to verify above

Question 6

Can type 2 diabetes be cured by lifestyle change?

Answer 6

DiRECT (diabetes remission clinical trial)Primary Outcome Results at 1 year1st Co-Primary Outcome: ≥15 kg weight loss
Intervention 36/149 (24%) p <0.0001
Control 0/149
2nd Co-Primary Outcome: Remission (not cure) of diabetes*
Intervention 68/149 (46%) p <0.0001
Control 6/149 (4%)
* HbA1c <48 mmol/mol, off all anti-diabetes medication for at least 2 months
2 weekly appointments with HCP trained in behaviour change using total meal replacement and reintroduction of food

Question 7

Diabetes 15 healthcare essentials

Answer 7

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

Question 8

What are the aims of nutrition education for diabetes?

Answer 8

A healthy balanced diet in order to achieve:
good blood glucose control
good blood fat levels
good blood pressure
a healthy weight

Question 9

What is the first line treatment for type 2 diabetes?

Answer 9

Lifestyle - nutrition and diet and exercise

Question 10

Diabetes can be prevented/medications can be reduced

Answer 10

Diabetes Prevention Study and Diabetes Prevention Programme studies both demonstrated a 50% reduction in risk of diabetes with a 5-7% weight loss ( at 4 years).
Look Ahead study demonstrated improvements in HbA1c, cholesterol and blood pressure with approx half the diabetes medication with 6% weight loss (at 4 years)

2 weekly appointments with HCP trained in behaviour change

Question 11

DASH mediterannean diet as primary prevention of cardiovascular disease

Answer 11

30 % reduction in cardiovascular events

30% reduction in diabetes (independent of weight loss)

Question 12

Types of diets

Answer 12

Mediterranean diet
Eatwell plate
DASH diet
Low carb
Time restricted eating
intermittent fasting
Nordic diet

Question 13

Type 2 diabetes main recommendations

Answer 13

Weight loss of at least 5%
Mediterranean style diet of equivalent healthy eating pattern
Individualised advice on quantity of carbohydrates
Encourage low GI foods and reduce total quantity of carbohydrate
Aim for at least 150 minutes of moderate to vigorous activity over 3 days
Decrease salt (<6g per day
Eat 2 portions of oily fish per week
Eat more wholegrains, fruit, veg, fish , nuts and pulses
Replace SFA with PUFA and MUFA
Limit alcohol <14 units

Question 14

Things to consider

Answer 14

Relevance to individual

Tailored to medication/ health

Personal choice. ?Achievable

A move from idealistic to realistic and pragmatic approach

Question 15

Carbohydrates

Answer 15

Quantity of carbohydrate
Distribution of carbohydrate.
Glycaemic index
Carbohydrate counting T1s Carbohydrate awareness T2s
Matching treatment to carbohydrate intake

Question 16

GI values

Answer 16

Low GI food – values below 55

Intermediate GI food – between 55 and 70

High GI food – over 70

Question 17

How much weight loss is enough?

Answer 17

Almost any amount of weight loss is beneficial: weight reductions as small as 2-5% can improve metabolic control

Question 18

Physical activity

Answer 18

Reductions in HbA1c, lipids and blood pressure independent to weight loss.
Increases self esteem.
150 minutes per week.

Question 19

How can healthcare professionals enhance self management for those “Living with diabetes”?

Answer 19

A move away from “advice giving”
Communication Skills – Motivational Interviewing. Guided discussions. Change talk.
Collaboration with the client.
Patient empowerment.
Education (when invited).

NOT JUST FOOD- This applies to all diabetes management.