Diabetic tissue damage
In most people's minds diabetes is sugar trouble. Yet most of the problems of diabetes arise, not from the ups and downs of the glucose concentration but from its many tissue complications. Diabetes is a chronic multisystem disorder of which one manifestation is hyperglycaemia. The tissue complications of diabetes are preventable and while we still have much to learn about the causes of diabetic tissue damage, we can at least work on reducing the damage due to factors we have identified....
St Vincent Declaration
Representatives of Government Health Departments and patients' organizations from all European countries met with diabetes experts under the aegis of the Regional Offices of the World Health Organisation WHO and the International Diabetes Federation IDF in St Vincent, Italy on October 10-12, 1989. They unanimously agreed upon the following recommendations and urged that they should be presented in all countries throughout Europe for implementation. Diabetes mellitus is a major and growing...
How to do a fingerprick blood glucose test
Like all laboratory techniques performed outside the laboratory, finger-prick blood glucose measurement is a waste of time unless it is done properly. Important factors are The finger Should be warm, clean, and dry. Wash with water then dry. Sticky fingers give falsely high blood glucose levels. The sides of the finger are less sensitive than the tip. Some people also use their ear lobe. Making the hole Lancets are for single use only and a fresh one is used each time. They can be used alone...
Guidelines for doctors
Examine every diabetic patient's feet on diagnosis and annually. On examination check Skin colour, ulcers, rubs, blisters, corns, calluses, etc. Foot and toe shape hammer or claw toes, bunions, missing toes, surgery, deformities Fig. 14.1 The diabetic foot warning signs during exami- Infection nation Pulses dorsalis pedis and posterior tibial Sensation light touch, Monofilament, vibration, position Colour change Red foot infection or 'sunset' ischaemic foot white no circulation blue black...
Insulin pen devices
These devices have an insulin cartridge instead of ink and a double-ended needle instead of a nib. This pierces the bung of the insulin cartridge ready for use. The insulin dose is dialled up or clicked in at the other end of the pen. A plunger pushes the bottom of the cartridge down, ejecting the chosen dose of insulin through the needle. Each device has a slightly different action. The pen does the same job as a syringe and needle but there is no need to draw up the insulin dose from a...
Disposal of sharps and syringes
It is each professional's and patient's personal responsibility to ensure that used sharps and used syringes are properly disposed of. Every patient should have a needle clipper B-D Safeclip and others and use it. The clipped and thus unusable syringes can then be put in a sharps box to be returned to the chemist, hospital, or surgery for formal disposal. Professionals must be aware of the potential for needle-stick injuries when clipping needles, emptying finger-pricking devices, and handling...
Implantable insulin infusion devices
There have been several implantable insulin pumps with an insulin reservoir which can be filled through the skin. The insulin is pumped either directly into a vein or intraperitoneally. At present they are mainly used as a last resort in people in whom no other method has succeeded in preventing frequent diabetic ketoacidosis. When reliable implantable glucose sensors are widely available there will be further exciting possibilities with implantable systems the aim being to have a fully...
Colleagues at work
People with diabetes on sulphonylureas or insulin should tell their work colleagues that they have diabetes. For insulin-treated patients it is sensible to teach one or two colleagues what to do in the event of hypoglycaemia. Everyone on insulin should carry glucose and a supply at work is essential. Some patients keep a supply of insulin and blood testing kit at work this must be locked away. People who give insulin injections at work should do so openly in a clean environment with...
Drawing up insulin
Drawing insulin into a syringe to the correct dose with no air requires dexterity, concentration, good vision, and a steady hand. The bottle of insulin should be in date and the top should be clean to clean use 70 per cent alcohol . Bottles of cloudy insulin should be rotated gently between two hands to mix the insulin. The insulin bottle is held vertically bung-down and the needle is inserted vertically so that insulin, not air, is drawn up. It is easier to withdraw insulin if air is injected...
The macula
To see this ask the patient to look at your light a macular beam is kindest if your ophthalmoscope has one . This is the area of best vision so problems here require urgent treatment. Fig. 13.1 Diabetic eye problems a cataract, b retinopathy Fig. 13.1 Diabetic eye problems a cataract, b retinopathy Macular oedema If the little pink dot which marks the fovea is blurred or if the whole macula appears swollen, the patient should be seen by an ophthalmologist within a month. Because the patient's...
Prandial glucose regulators
Like sulphonylureas, these drugs act by increasing insulin release from the pancreas. The main advantage is rapid absorption and action which means they can be taken before meals whenever they are. Because of the short duration of action these agents MONITORING OF ORAL HYPOGLYCAEMIC THERAPY 73 are unlikely to cause hypoglycaemia, and may be particularly helpful in patients who suffer fasting hypoglycaemia on sulphonylureas. They may be combined with metformin, but not with other...
Factors affecting insulin absorption
These are myriad and tend to be forgotten when the patient and diabetes adviser are poring over the blood glucose diary. The size of the insulin depot and the amount of fat surrounding the depot affects absorption. The rate of entry into the blood stream is determined by the circulation through and from the injection site. Thus cold or other stimuli causing vasoconstriction such as nicotine or drugs will reduce absorption, as will shock from whatever cause. Heat will increase absorption as will...
Diabetic nephropathy
If the microalbumin concentration is raised check for infection midstream urine microscopy and culture . If infection is present treat it and then repeat the microalbumin estimation after the infection has settled. Cardiac failure may also produce microalbuminuria. If the creatinine is raised perform a creatinine clearance test. Note that small people or those with low muscle bulk should have creatinine levels at the lower end of the normal range. Do a creatinine clearance if their creatinine...