Diabetes Week is organised annually by Diabetes UK to raise awareness and encourage everyone to talk about diabetes. This year, Diabetes UK has used the hashtag #TheBigPicture to show “the triumphs, the setbacks, the daily routines and the unexpected turns, with an aim to build a better future for those with diabetes”.
Despite the misconception that there are only two types of diabetes, there are actually seven types. These are:
Individuals may also suffer from steroid induced diabetes, secondary diabetes or pre-diabetes.
Each type of diabetes is different, but the most commonly known variants are Type 1 and Type 2. There are huge differences between these two types and, although the cause of Type 1 is unknown, the cause of Type 2 diabetes is often linked to lifestyle choices and being overweight. There are approximately 400,000 people currently living with Type 1 diabetes in the UK, with over 29,000 of them children. Type 2 is the most common type of diabetes, with over 90% of the diabetic population in the UK diagnosed with the illness.
Type 1 diabetes is not curable, and the only way to treat the condition is with insulin, which is either injected or infused into the body by way of an insulin pump. In order to ensure they are giving themselves the correct amount of insulin, Type 1 diabetics must regularly test their blood sugars, often by pricking their fingers. Meal times may be difficult because most Type 1 diabetics must also count the volume of carbohydrates that they will be consuming and work out the corresponding amount of insulin they require. JDRF UK, a Type 1 diabetes charity, estimates that “a person with Type 1 diabetes will have around 65,000 injections and measure their blood glucose over 80,000 times in their lifetime”.
Type 2 diabetes occurs as a result of the cells in the body becoming resistant to producing insulin. If this is not dealt with quickly, the pancreas will start making less and less insulin until it no longer produces any. Most of the time, Type 2 diabetes can be treated with drugs such as metformin, but once the pancreas stops producing insulin completely, a Type 2 diabetic will more than likely require one or two insulin injections per day. Individuals with Type 2 diabetes are also required to test their blood sugars, but this is also often limited to once or twice a day. Although Type 1 diabetes cannot be cured, it is possible to put Type 2 diabetes in remission, which occurs when the pancreas slowly starts to reproduce insulin.
Although all types of diabetes can cause complications, they are most common within Type 1 and Type 2. Without good control, or through poor medical management, the following complications could arise:
Other complications that could arise due to poor management or delayed treatment include diabetic ketoacidosis (DKA) and brain damage. It is important that if you, or anyone you know, is diabetic and has concerns relating to any of these issues, to please seek medical attention as soon as possible.
I write this article as a Type 1 diabetic of 19 years. The aim of Diabetes Week is to show #TheBigPicture in terms of living with diabetes. Although I live a pretty normal life, it is very difficult and a constant challenge. I don’t want sympathy, but I think it is important to share what a diabetic’s life looks like in order to spread awareness and help improve treatment for those in the future.
On average, I test my blood sugars 14 times per day. I use a device called the Freestyle Libre, which means I don’t have to physically prick my fingers, but insert a device into my arm which lasts for 14 days, and scan it each time I need to check my blood sugars. This product has only been on the market for the last few years, and prior to my receiving this on the NHS, I self-funded at a cost of £100 per month. Before every meal or snack, I must scan my blood sugars to work out the correct dosage of insulin to give myself, as well as calculating the amount of insulin to give alongside my meal. I have to weigh out or make an educated guess regarding the number of carbohydrates within my meals and adjust my insulin accordingly. Throughout the day, I also test my sugars to ensure they are in a sensible range. Unfortunately, this isn’t as easy as you would expect and a number of factors can impact upon this process, including stress, the weather, being unwell, the ovulation cycle and exercise.
On average, I sleep for five hours per night. It is a known fact that diabetics struggle with sleeping. There are occasions where I have woken up in a bed of cold sweat because my blood sugars have dropped so quickly. When blood sugars drop (hypoglycaemia), I have to treat myself by eating fast-acting carbohydrates such as jelly babies or a glass of Lucozade. If you do not treat hypoglycaemia quickly enough, you are at risk of slipping into a coma and ultimately, dying. There have been cases where people have had a hypoglycaemic episode during their sleep and not woken up. This is more common if you live alone. When treating low blood sugars, I have to be careful not to give myself too much and cause my blood sugars to go the opposite way, and cause hyperglycaemia. If my blood sugars are high, I constantly have to get up in the night to urinate. If you do not treat hyperglycaemia, you run the risk of having ketones, which can ultimately lead to diabetic ketoacidosis (DKA), causing your body to shut down.
Ensuring my blood sugars are within a stable range and preventing both hypoglycaemia and hyperglycaemia is a daily task and causes worry and stress. I know that if I try and look after myself it will prevent complications later on in life, but I am not guaranteed that I will be complication free. Diabetes is a part of me, but I control my diabetes, not the other way round.
At Penningtons Manches Cooper, the clinical negligence team deals with a significant number of cases involving diabetes. The main issues that we assist with are delayed diagnosis or misdiagnosis claims, or claims made as a result of treatment falling below an acceptable standard.
Diabetics should attend regular appointments that should identify any potential complications, but sadly this does not always occur. The diagnosis and treatment of diabetic retinopathy is often missed or delayed and if not treated correctly can cause partial or complete blindness.
Another common clinical negligence claim involving diabetes relates to foot sores not being treated. Diabetics heal slower than non-diabetics, and if they suffer from a foot sore, clinicians should treat these promptly. A delay can result in a worsening sore and/or amputation, which could have been avoided with the correct treatment.
Unfortunately, there are too many occasions when Type 1 and Type 2 diabetes get confused, or when people, including doctors, nurses and physicians, do not understand the conditions.
I have been on the front line of this kind of issue when I was being treated in hospital for an unrelated illness in accident and emergency. When a diabetic is unwell, normally their blood sugars run high and become more difficult to control. As long as you have no ketones, the main concern is to make yourself better. I had a consultation with a doctor who thought my blood sugars were running too high and despite me telling her this was normal, she instructed the nurses to find me some fast-acting insulin to inject. Despite me telling them my blood sugars would drop without me eating following an injection of my normal breakfast amount, the nurses gave me a full dose of insulin. A few hours later, I was alone in my hospital room and started fitting. My mum came into the room and instantly raised the alarm, tested my sugars and encouraged the medical team to give me glucose. My blood sugars had dropped so low that they had caused me to go into a hypoglycaemic fit. Thankfully I was treated quickly and suffered no complications as a result of that fit, and it made my diabetes team provide extra training for all doctors within the hospital, including those in accident and emergency. Had this experience caused any further complication, I could have made a clinical negligence claim against the hospital.
Within the clinical negligence team, we also advise on product liability claims and have seen cases where medication and/or medical devices have been recalled as they have caused injury to clients. In 2019, Medtronic, the world’s leading insulin pump provider, recalled its MiniMed pump as a result of incorrect insulin dosing. If too much or too little insulin is administered by a pump, complications can arise and a claim could potentially be made against the manufacturer.
If you are worried about any of the issues in this article, or have concerns that you may have a potential case relating to your diabetes, we would be happy to discuss this further on an informal, no obligation basis.