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Diabetes and Endocrinology Care
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What is Diabetes?
Diabetes Mellitus is not a single hereditary disease but a heterogeneous group of diseases, all of which ultimately lead to an elevation of glucose in the blood (hyperglycaemia) and loss of glucose in the urine as hyperglycaemia increases.

It is also characterised by the three "polys" and inability to reabsorb water, resulting in increased urine production (polyurea) excessive thirst (polydipsia) and excessive eating (polyphagia).


Type 1 Diabetes

Occurs abruptly, characterised by an absolute deficiency of insulin due to a marked decline in the number of insulin producing beta cells (perhaps caused by the auto immune destruction of beta cells) even though target cells contain insulin receptors.

Type 1 diabetes is also known as insulin dependant diabetes and juvenile onset diabetes, as it most commonly develops in people under 20 years old though it persists through life, and requires periodic insulin injections to treat it.

Although type 1 diabetes appears to have certain genes which make them more susceptible, some triggering factor is required e.g. viral infection, shock etc.


Type 2 Diabetes

It most often occurs in people who are over forty and overweight hence another name "maturity onset diabetes". Clinical symptoms are mild, and high glucose levels in the blood can usually be controlled by diet, exercise, and/or with anti diabetic drugs. Some type II diabetes have sufficient amounts of insulin in the blood, but they have defects in the molecular machinery that mediates the action of insulin on its target cells, cells can become less sensitive to insulin because they have fewer insulin receptors.

Type II diabetes is therefore called non-insulin dependant diabetes. 90% of all cases are type II.

Insulin pump therapy
We run an established insulin pump service, including pumps in pregnancy. An insulin pump is an external, battery operated device, roughly the size of a pager. The pump itself does not test blood glucose levels, but is programmed on an individual basis to work with the information that the patient inputs to deliver an appropriate insulin dose.

NICE has produced guidance on funding criteria for insulin pump therapy; patients will require education on carbohydrate counting and pump management.