What is diabetes?

Most of the food you eat is turned into glucose for your body to use for energy. Your pancreas makes a hormone called insulin to help glucose get into the cells of your body. Your diabetes is a common life-long condition where the amount of glucose in your blood is too high as your body cannot use it properly. This is because your pancreas does not produce any or not enough insulin, or the insulin that is produced doesn’t work properly.

Diabetes Types & Symptoms

You are one of more than 220 million people worldwide that have one of the following types of diabetes:

Type 1 diabetes develops when the insulin-producing cells have been destroyed and the body is unable to produce any insulin. Usually it appears before the age of 40, and especially in childhood. It is treated with daily administration of insulin either by injection or pump, a healthy diet and regular physical activity. Symptoms include frequent urination, excessive thirst, extreme hunger, unusual weight loss, vision changes, fatigue and irritability. These symptoms may occur suddenly.

Type 2 diabetes develops when the body does not produce enough insulin or the insulin that is produced does not work properly. Usually it appears in people aged over 40 as a result of excess body weight and physical inactivity, though in South Asian and Black people it can appear from the age of 25. It is becoming more common in children and young people of all ethnicities. This condition is treated with a healthy diet and regular physical activity, but medication and/or insulin is often required. Symptoms may be similar to those of Type 1 diabetes (others include frequent infections, blurred vision, cuts/bruises that are slow to heal, tingling/numbness in the hands/feet, recurring skin, gum or bladder infections) but are often less marked. As a result, the disease may be diagnosed several years after onset once complications have already arisen.

Gestational diabetes is hyperglycaemia (abnormally high blood sugar levels) with onset or first recognition during pregnancy. This condition is most often diagnosed through prenatal screening rather than reported symptoms (similar to Type 2 diabetes).

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes.

Who is at Greater Risk for Type 2 Diabetes?

  • Individuals with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
  • People over 45 years or with a family history of diabetes
  • Those who are overweight, do not exercise regularly, have low HDL cholesterol or high triglycerides, high blood pressure
  • Certain racial and ethnic groups
  • Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth.

Download ‘What is Diabetes?’ leaflet

Download ‘Diabetes & Pregnancy’ leaflet

Download ‘Diabetic Ketoacidosis’ leaflet

Diabetes Prevention

To delay the onset of type 2 diabetes and its complications, it is important to:

  • achieve and maintain normal body weight
  • be physically active – at least 30 minutes of regular, moderate-intensity activity on most days (more activity is required for weight control)
  • eat a healthy diet of between three and five servings of fruit and vegetables a day, and reduce sugar and saturated fats intake
  • avoid tobacco use as smoking increases the risk of cardiovascular diseases.

Diabetes Treatment

The main aim when treating your diabetes is to achieve blood glucose, blood pressure and blood fat levels (including cholesterol) as near to normal as possible. Other interventions include:

  • foot care
  • screening for retinopathy (which causes blindness)
  • blood lipid control (to regulate cholesterol levels)
  • screening for early signs of diabetes-related kidney disease.
  • These, together with a healthy lifestyle, will help to improve your wellbeing and reduce the risk of developing long-term complications such as heart disease, stroke, lower-extremity amputation, blindness, kidney failure and nerve damage.

Download ‘Diet & Exercise’ leaflet

Diabetes & Travel

People with both Type 1 and Type 2 diabetes holiday all over the world, their condition certainly being no barrier. If you plan ahead and seek advice wherever necessary, you should be able to minimise any potential problems and have an enjoyable and safe trip. How you prepare for a trip will depend where you are going and what you are doing, i.e. if you are going on an active adventure you need to work out what influence extra exercise will have on your blood sugar levels.

Your diet while away from home

If you generally follow a healthy, balanced diet there is no harm in experimenting with different foods whilst on holiday by making some higher fat/sugar choices from the local menu. You should let your holiday destination know in advance if there are certain foods you want. If you are traveling alone, you may like to let staff know in case you are taken unwell during your stay.

Things to check out before you go and equipment to take

  • Get the necessary vaccinations.
  • Allow two weeks to buy your travel insurance. Don’t just buy according to price; check the cover for emergency transport home and recovery of charges for replacement of insulin/equipment. Also read the small print. Be honest and declare all medical conditions. It is recommended that all members of your holiday party travel under the same policy.
  • Plan to take twice the quantity of medical supplies (insulin, syringes or pens, needles or tablets, BGM supplies and a spare battery for your meter) you would normally use for your diabetes. If travelling with someone else, split the amount between each passenger’s hand luggage in case one of the bags is lost.
  • Ensure you have the new European Health Insurance Card (EHIC) if you are travelling to a European Union member country for easy healthcare access in that country.
  • A basic first aid box.
  • A list of all current medication.

Air travel and insulin

Diabetics can still take insulin with them onto an aircraft despite new security restrictions. If you are traveling you should bring a letter from your doctor explaining your need to carry syringes/injection devices and insulin for presentation to airline staff. If you encounter any problems, ask to speak to a more senior member of staff. Some GPs charge you for writing such a letter. Therefore if you travel frequently, it would be a good idea to ask your doctor to phrase the letter so that it can be used again.

Additionally a Diabetes UK Insulin user’s identity card (available from www.diabetes.org.uk) or engraved jewellery may help you verify your need to carry syringes and medication.

Airlines do bring in restrictions in emergency situations about what items can be brought onto their aircraft in hand luggage. Insulin manufacturers have always advised to avoid storing insulin in baggage which goes into the hold as travelling at altitude may freeze the baggage and damage insulin. Insulin that has to go in the hold should be placed in an airtight container (such as a flask) in the middle of your suitcase, or wrapped in bubble wrap, then in a towel and again place in the middle of your suitcase. On arrival to your destination you must examine your insulin for crystals and discard if any are found. Even if the insulin looks okay, you should test your blood glucose levels more frequently and if they appear abnormal, discard the insulin as it may be damaged and ineffective.

Once on board some airlines, cabin crew may request that your medication be handed over for storage during the flight. For this reason you should put the insulin and syringes/needles in a separate carrier bag/hand luggage.

Long haul

  • If travelling for many hours, specific advice regarding adjustments to insulin regimes/medicine timings across the different timezones can be obtained from your diabetes care specialist. Be prepared for transport delays.
  • Travel to areas of high altitude can cause insulin to expand and contract, resulting in air pockets within the cartridge or pen. You may need to do a few “air shots” to make sure that there are no air bubbles present when you inject, or alternatively use a syringe and needle.

Airline catering

People with diabetes need to eat regularly to help control their blood glucose levels. Special ‘diabetic’ meals are not necessary on board planes as they are often low in carbohydrate. Thus it is recommended that diabetics select meals from the standard airline menu items and that:

  • Bread or fruit or biscuits are available between meals on flights over three hours (you should carry extra carbohydrate in the form of sandwiches, fruit, cereal bars etc in your hand luggage if required, especially for long haul flights).
  • Low-calorie/diet beverages are freely available.

Using insulin abroad

  • Insulins used in the UK and many other countries are of strength U-100. In some countries insulin may come as U-40 or U-80 strengths; these insulins are not interchangeable and appropriate syringes are required.
  • Insulin may be absorbed faster in warmer climates. Regular glucose monitoring is important to allow for safe adjustments in dose. High altitude and humidity can sometimes affect meters and test strips – you should be aware of false readings.

Blood glucose conversions

In some countries, including the USA and many EU countries, blood glucose is measured in milligrams per 100 millilitres (expressed as mg %) and not in millimoles per litre (mmol/l), as it is in the UK. A blood glucose conversion chart is shown below:

MMOL/L MG %
1 18
2 36
3 54
4 72
5 90
6 108
7 126
8 144
9 162
10 180
11 198
12 216
13 234
14 252
15 270
16 288
17 306
18 324
19 343
20 360
21 378
22 396
23 414
24 432


Keeping insulin cool

Firstly check if you are going to a very hot country or on a long, hot car journey as you will need to keep your insulin cool and protected. Insulin can withstand short trips when not refrigerated but it’s the exposure to direct sunlight and extremes of heat that can deactivate it. Below is a list of bags, wallets, fridges and travel friendly accessories that will allow you to keep your insulin cool on the move:

  • Medicool: PenPlus range
  • Frio Wallets and Carry Cases
  • MediFridge
  • Chillerz Packs, Polar Gear and Generic Cool Packs.

Foot care whilst travelling

  • Travel with comfortable, well-fitting shoes in case your feet swell.
  • Do not walk barefoot, particularly on hot sand.
  • Keep checking your feet every evening and morning. If you develop a blister stay out of the sea, cover it with a plaster and keep it clean.

Driving

If you are planning to drive while on holiday, ensure your licence is valid for the duration of the trip and that you are covered by your insurance policy for driving, especially when abroad.

UK Standards for drivers with diabetes – updated 20th September 2011

Dealing with illness while abroad

  • If you suffer from sickness or diarrhoea, insulin or tablets should never be stopped – even if solid foods cannot be tolerated.
  • Carbohydrate intake should be maintained in the form of regular sugary drinks.
  • Monitor your blood glucose levels frequently.
  • Urine should be tested for ketonuria as an early sign of decompensation.
  • If sickness or diarrhoea persists, seek medical advice.

Download ‘Diabetes & Travel, Driving’ leaflet

Diabetes Resources

MMOL/L MG %
Diabetes UK http://www.diabetes.org.uk/
Diabetes.co.uk http://www.diabetes.co.uk/
NHS Diabetes
http://www.diabetes.nhs.uk/
Association of British Clinical Diabetologists http://www.diabetologists-abcd.org.uk/
American Diabetes Association http://www.diabetes.org/
International Diabetes Federation http://www.idf.org/
World Health Organisation http://www.who.int/topics/diabetes_mellitus/en/
Children with Diabetes http://www.childrenwithdiabetes.com/
MedlinePlus http://www.nlm.nih.gov/medlineplus/diabetesmellitus.html
Nutritionist Resource – Diabetes http://www.nutritionist-resource.org.uk/articles/diabetes.html
Drugwatch - Diabetes https://www.drugwatch.com/diabetes/
Drugwatch - Diabetes Stigma https://www.drugwatch.com/featured/diabetes-stigma/

PLEASE NOTE:

These sites are in no way affiliated with www.keysmart.com we provide these links for your convenience only.

Why you may get different results when you compare meters from different manufacturers.

Many people want their meters to have laboratory-level accuracy, which is understandable. But to do so meters would have to have much more complicated technology, which could get exceptionally expensive for both the patient and health care system. When it comes to health outcomes, experts agree that accuracy at every blood glucose level is less important than accuracy at levels for which a wrong number is most likely to cause a clinical error, for example in the hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar) regions where dosing too much or too little insulin may have an adverse effect on the user.

When people compare their glucose readings from a new meter with their previous meter, it is not unusual that the readings they get on their new meters will be different. For some, the difference is concerning, and they consider that their old meter has the right reading and their new meter must be wrong. However, variances are normal between hand held meters and are to be expected. The reason for this, is how different manufacturers calibrate their meters whilst still maintaining the high standard required for accuracy.

The Food and Drug Administration (FDA) in America and the International Organization for Standardisation (ISO) in Europe have accuracy requirements for all blood glucose monitoring system that are marketed for use by diabetics which in turn, allow for a range of readings. These standards stipulate the following.

For results at or above 100 mg/dl glucose (or 5.5mM) 95% of meter test results must be within plus or minus 15% of the actual blood glucose level that would be measured in a hospital laboratory. This means that a subject with an actual blood glucose result of 180 mg/dl (10mM) could potentially show on a meter any value from 153 mg/dl (8.5mM) to 207 mg/dl (11.4mM) and still meet the requirement of the standard. Taking the extreme cases, two meters would still be considered accurate if on the same sample of blood they displayed glucose values of 153 mg/dl and 207 mg/dl.

For results below 100 mg/dl, 95% of test results must be within plus or minus 15 points of the actual blood glucose level. The same logic applies to these glucose readings. For example, a subject with an actual blood glucose result of 70 mg/dl (3.9 mmol/L) could potentially show on a meter as any value from 55 mg/dl (3.0 mmol/L) to 85 mg/dl (4.7 mmol/L) and meet the standard. Some people are aware of this 15% variance, but think that this means that there can only be a 15% difference between the readings of two meters, rather than between a meter and a lab test.

Many people want their meters to have laboratory-level accuracy, which is understandable. But to do so, meters would have to have much more complicated technology, which could get exceptionally expensive. When it comes to health outcomes, experts agree that accuracy at every blood glucose level is less important than accuracy at levels for which a wrong number is most likely to cause a clinical error. Those are results that might encourage you to make a possibly harmful decision about not treating hypoglycaemia (low blood glucose) or dosing too much insulin for what appears to be high blood glucose. This fact is addressed in the required FDA and ISO accuracy standards to ensure that this never happens. It should also be appreciated, that meter manufacturers are required to continually assess the accuracy of their meters. In addition, many hospital and academic laboratories consistently test and publish accuracy results for commercially available blood glucose meters.

The key message for people with diabetes is that directly comparing results between meters is not best clinical practice. It may be useful for a short period of time, while becoming familiar with the new meter, but it is important to reinforce that meter readings from any meter are only indicative. The most meaningful information is to understand the trends, and what the readings mean for them and their diabetes management. This is best achieved in partnership with the health care professional.

If you have diabetes, your blood-glucose meter is a critical tool that gives you the necessary insight as to what’s going on inside your body at a given moment—an absolutely essential piece of knowledge, particularly if you use insulin.

That’s why it’s important to ensure that your meter is functioning correctly and giving you accurate readings. To verify this, start by periodically using a standard glucose solution, also known as control solution, provided by your meter’s manufacturer to test the accuracy of the results you’re getting. You generally should also use liquid control solutions if you drop your blood glucose meter, or whenever you get unusual results.

Match your reading with lab results. Take the blood glucose monitor along when you visit your doctor or have an appointment for lab work. Check your blood sugar level with your meter at the same time that blood is drawn for lab tests. Then compare your meter's reading with the lab results. Results that are within 15 percent of the lab reading are considered accurate. If your meter isn't working properly, contact the manufacturer of your meter and test strips and ask for a replacement. Finally, watch out for these common factors that can affect your meter readings:

Out of date test strips - Dispose of damaged or outdated test strips; lack of enzyme coverage in these can cause inaccuracies. Store your strips in their sealed container, away from heat, moisture and humidity. Be sure the strips are meant for your specific glucose meter.

Out of date Control Solution

Substances on your hands.

Temperature changes. Your meter user’s manual (or web site) will tell you the temperature range in which your meters will function correctly.

Hand washing your testing site with soap and water and proper drying is very important with new smaller-volume meters now. The tiniest amount of dirt, alcohol or other skin contaminant can significantly raise blood glucose Wet fingers mixing with blood may cause an inaccurate reading.

Download further information on Factors affecting blood glucose monitoring: Sources of Errors in Measurement

Download Review Article on Interferences and Limitations in Blood Glucose Self-Testing