About diabetes
There is more than one kind. Type 1 diabetes is an autoimmune condition in which the pancreas stops making insulin; it needs insulin from the start. Type 2 diabetes develops when the body becomes resistant to insulin and the pancreas cannot keep up; it is far more common and is closely linked to weight, activity and family history. Gestational diabetes appears during pregnancy and usually resolves after birth, but raises the risk of type 2 diabetes later. Pre-diabetes means glucose is above normal but not yet in the diabetic range, and is the point at which lifestyle change has the most effect.
Less common forms include monogenic diabetes, caused by a change in a single gene, which is often misdiagnosed as type 1 or type 2 and treated differently. Dr Zamuner has a particular research interest in these forms.
Symptoms we assess
Type 2 diabetes often causes no symptoms at all and is picked up on a routine blood test. When symptoms do occur, the common ones are:
- Passing urine more often, particularly at night
- Increased thirst and a dry mouth
- Tiredness that does not improve with rest
- Unexplained weight loss (more typical of type 1)
- Blurred vision
- Slow-healing cuts, recurrent thrush or skin infections
- Tingling or numbness in the feet
How we diagnose it
Diabetes is confirmed with blood tests. HbA1c measures average glucose over the previous two to three months and is the usual test for type 2 diabetes and pre-diabetes. A fasting glucose or an oral glucose tolerance test may be used instead, particularly in pregnancy. Where the type of diabetes is unclear, antibody tests and C-peptide help distinguish type 1 from type 2, and genetic testing is considered where a monogenic form is suspected.
At your first appointment the consultant reviews your results, your weight and blood pressure, your family history and any complications, and checks kidney function, cholesterol and, where needed, eye and foot screening. If you already use a glucose meter or sensor, bring the readings or the app.
Treatment and follow-up
Treatment depends on the type of diabetes and on you. For type 2 diabetes and pre-diabetes the first step is a realistic plan for food, activity and weight, because these change glucose levels more than any single tablet. Where medication is needed there is now a wide choice, including newer agents that also protect the heart and kidneys and help with weight. The consultant chooses with you, and explains what each medicine does and what to watch for.
Type 1 diabetes is treated with insulin, either by injection or pump, and the clinic reviews doses, carbohydrate counting and continuous glucose monitoring data. Gestational diabetes is managed with diet first and medication where glucose targets are not met, in close contact with your maternity team.
Follow-up is agreed at the first visit. Some patients need a single review and a plan their GP then runs; others, particularly those on insulin, stay under regular consultant review. Either way your GP receives a full letter after every visit.
When to see a GP, and when to see a consultant
Your GP can diagnose and manage most type 2 diabetes. Ask for a consultant referral if glucose control is not reaching target despite treatment, if you have type 1 diabetes, if you are pregnant or planning a pregnancy, if the type of diabetes is uncertain, or if complications are developing. Very high glucose with vomiting, drowsiness or rapid breathing is an emergency and needs same-day hospital care.
