Diabetes mellitus is a condition characterized by a chronically raised glucose level in the blood known as hyperglycaemia. Glucose is used by the body for energy production and comes from carbohydrate food sources, e.g. sugars and starch. Digestion breaks down the carbohydrates into glucose, which is then released into the blood. The pancreas is a gland in the body situated behind the stomach. One of the functions of the pancreas is to make a hormone called insulin. Insulin moves glucose from the bloodstream into the cells of the body where it is needed, for example, muscle cells. Raised blood glucose levels are caused by a lack of the insulin or by the body’s inability to use the insulin properly, known as insulin resistance. Whichever the cause, the blood glucose levels remain high and not enough energy gets to the cells and muscles.
Monitoring of diabetes is essential. It is important that all individuals with diabetes receive at least annual reviews at their local hospital or GP surgery. The purpose is to determine if treatment is satisfactory and to identify any evidence of longer-term complications. People with diabetes have up to a fivefold increased risk of cardiovascular disease (heart attacks, strokes and blockages to the vessels in the feet and legs) compared with those without diabetes.. This is because of prolonged, poorly controlled, elevated blood glucose levels, which affect the lining of the body’s arterial walls. This increases the likelihood of the blood vessels becoming narrower and sometimes getting blocked. Managing diabetes therefore includes not only achieving good glycaemic (blood glucose) control but also controlling weight, blood pressure, cholesterol and, quit smoking.
Other complications include: Nephropathy (damage to the kidneys). Long-standing diabetes causes changes in small blood vessels that can lead to damage of the kidneys; this damage can result in severe kidney failure.
Neuropathy (damage to the nerves) is long-term damage to the nerve fibres. It happens when high blood sugar levels are present over several years. In diabetes, the form it usually first takes is reduced sensation in the feet and this makes them more prone to injury, combined with poor circulation this can easily lead to ulcers and infections.
Retinopathy (damage to the eyes) is an eye disease that is a major cause of poor vision in the UK. If left untreated, diabetic retinopathy can lead to blindness. Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. These complications are irreversible but the progression may be halted if the diabetes is under control.
Diabetes is a serious illness and it takes lots of effort to get it right. On top of checking blood glucose levels, diet has to be considered, taking regular exercise, administering medication on a daily basis and visiting the GP or hospital specialist, sometimes a number of times a year. All of these stresses can take their toll. Trying to manage treatment plans and keep blood glucose levels within normal ranges on a daily basis requires a high level of motivation from those living with diabetes and ongoing support and understanding from health professionals. Health care assistants and assistant practitioners may be involved very closely with the care of patients with diabetes and should be aware of their emotional as well as their physical needs at all times.
The future of diabetes in primary care looks bright and will depend on the commitment of health authorities, GPs and primary care teams to the development of innovative approaches to diabetes services based on good evidence. A commitment to their own training and continuing education by all members of the primary care team involved in providing diabetes care is the single most important element for success. Development of all aspects of multidisciplinary team working is essential to the provision of up-to-date and continuing education and support for people with diabetes in a local, comprehensive and organized setting. New approaches to diabetes care might involve community pharmacists and those involved in local and voluntary services. Planning the practice service should always involve those who receive it, both people with diabetes and their relatives and carers. There are many examples of new approaches to health promotion and education. It is important that ideas locally and nationally are shared and that new schemes are piloted and evaluated as health resources are limited. Primary care teams providing diabetes services should use locally agreed district guidelines in developing their own practice programmes, which should be tailored to their particular practice population. The population-based diabetes register in every practice will underpin the programme of care which is the right of every person with diabetes.