WHAT ARE CD4 CELLS?
CD4 cells are a type of lymphocyte (white blood cell). They are an important part of the immune system. CD4 cells are sometimes called T-cells. There are two main types of T-cells. T-4 cells, also called CD4+, are "helper" cells. They lead the attack against infections. T-8 cells, (CD8+), are "suppressor" cells that end the immune response. CD8+ cells can also be ?killer? cells that kill cancer cells and cells infected with a virus. Researchers can tell these cells apart by specific proteins on the cell surface. A T-4 cell is a T-cell with CD4 molecules on its surface. This type of T-cell is also called ?CD4 positive,? or CD4+.
WHY ARE CD4 CELLS IMPORTANT IN HIV?
When HIV infects humans, the cells it infects most often are CD4 cells. The virus becomes part of the cells, and when they multiply to fight an infection, they also make more copies of HIV.
When someone is infected with HIV for a long time, the number of CD4 cells they have (their CD4 cell count) goes down. This is a sign that the immune system is being weakened. The lower the CD4 cell count, the more likely the person will get sick.
There are millions of different families of CD4 cells. Each family is designed to fight a specific type of germ. When HIV reduces the number of CD4 cells, some of these families can be totally wiped out. You can lose the ability to fight off the particular germs those families were designed for. If this happens, you might develop an opportunistic infectionWHAT FACTORS INFLUENCE A CD4 CELL COUNT?
The CD4 cell value bounces around a lot. Time of day, fatigue, and stress can affect the test results. It's best to have blood drawn at the same time of day for each CD4 cell test, and to use the same laboratory.
Infections can have a large impact on CD4 cell counts. When your body fights an infection, the number of white blood cells (lymphocytes) goes up. CD4 and CD8 counts go up, too. Vaccinations can cause the same effects. Don't check your CD4 cells until a couple of weeks after you recover from an infection or get a vaccination.HOW ARE THE TEST RESULTS REPORTED?
CD4 cell tests are normally reported as the number of cells in a cubic millimeter of blood, or mm3. There is some disagreement about the normal range for CD4 cell counts, but normal CD4 counts are between 500 and 1600, and CD8 counts are between 375 and 1100. CD4 counts drop dramatically in people with HIV, in some cases down to zero.
The ratio of CD4 cells to CD8 cells is often reported. This is calculated by dividing the CD4 value by the CD8 value. In healthy people, this ratio is between 0.9 and 1.9, meaning that there are about 1 to 2 CD4 cells for every CD8 cell. In people with HIV infection, this ratio drops dramatically, meaning that there are many times more CD8 cells than CD4 cells.
Because the CD4 counts are so variable, some health care providers prefer to look at the CD4 percentages. These percentages refer to total lymphocytes. If your test reports CD4% = 34%, that means that 34% of your lymphocytes were CD4 cells. This percentage is more stable than the number of CD4 cells. The normal range is between 20% and 40%. A CD4 percentage below 14% indicates serious immune damage. It is a sign of AIDS in people with HIV infection. A recent study showed that the CD4% is a predictor of HIV disease progression.WHAT DO THE NUMBERS MEAN?
The meaning of CD8 cell counts is not clear, but it is being studied.
The CD4 cell count is a key measure of the health of the immune system. The lower the count, the greater damage HIV has done. Anyone who has less than 200 CD4 cells, or a CD4 percentage less than 14%, is considered to have AIDS according to the US Centers for Disease Control.
CD4 counts are used together with the viral load to estimate how long someone will stay healthy. See Fact Sheet 125 for more information on the viral load test.
CD4 counts are also used to indicate when to start certain types of drug therapy:
When to start antiretroviral therapy (ART):
When the CD4 count goes below 350, most health care providers begin ARTAlso, some health care providers use the CD4% going below 15% as a sign to start aggressive ART, even if the CD4 count is high. More conservative health care providers might wait until the CD4 count drops to near 200 before starting treatment. A recent study found that starting treatment with a CD4% below 5% was strongly linked to a poor outcome.
When to start drugs to prevent opportunistic infections:
Most health care providers prescribe drugs to prevent opportunistic infections at the following CD4 levels:
- Less than 200: pneumocystis pneumonia (PCP)
- Less than 100: toxoplasmosis and cryptococcosis
- Less than 75: mycobacterium avium complex (MAC).
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However, the viral load test measures the virus itself. Before the immune system produces antibodies to fight it, HIV multiplies rapidly. Therefore, this test will show a high viral load during acute infection.
A negative HIV antibody test and a very high viral load indicate recent HIV infection, most likely within the past two months. If both tests are positive, then HIV infection probably occurred a few months or longer before the tests. A special "detuned" version of the HIV antibody test is less sensitive. It detects only those infections that occurred at least four to six months before testing. It can be used to help identify cases of acute HIV infection.RISK OF IMMUNE DAMAGE
Some people think that there?s not much harm done in the early stages of HIV infection. They believe that any damage to their immune system will be cured by taking antiretroviral therapy (ART). This is not true! Up to 60% of infection-fighting ?memory? CD4 cells are infected during acute infection, and after 14 days of infection, up to half of all memory CD4 cells can be killed. Also, HIV quickly reduces the ability of the thymus gland to replace lost CD4 cells. The lining of the intestine is also damaged very quickly. This can all occur before a person tests positive for HIV.
RISK OF INFECTING OTHERS
The number of HIV particles in the blood is much higher during acute HIV infection than later on. Exposure to the blood of someone in the acute phase of infection is more likely to result in infection than exposure to someone with long-term infection. One research study estimated that the risk of infection is approximately 20 times higher during acute HIV infection.TREATING ACUTE HIV INFECTION
At first, the immune system produces white blood cells that recognize and kill HIV-infected cells. This is called an "HIV-specific response." Over time, most people lose this response. Unless they use antiretroviral drugs (ARVs), their HIV disease will progress.Guidelines for using HIV medications recommend waiting until the immune system shows signs of damage. However, starting ARVs during acute HIV infection might protect the HIV-specific immune response.
Researchers have studied people who start treatment during acute infection and then stop taking ARVs. One study showed that this treatment may delay the time until ART is needed. Researchers are doing more studies.PROS AND CONS OF TREATING ACUTE HIV INFECTION
Starting ART is a major decision. Anyone thinking about taking ARVs should carefully consider the benefits and disadvantages.Taking ART changes your daily life. Missing doses of drugs makes it easier for the virus to develop resistance to medications, which limits future treatment options.
The medications are very strong. They have side effects that can be difficult to live with for a long time, and they can be very expensive.
Early treatment can protect the immune system from damage by HIV. Immune damage shows up as lower CD4 cell counts and higher viral loads. These are associated with higher rates of disease. Older people (over 40 years old) have weaker immune systems. They do not respond to ARVs as well as younger people.
However, not everyone with HIV gets sick right away. Someone with a CD4 cell count over 350 and a viral load under 20,000, even if they don?t take antiviral drugs, has about a 50/50 chance of staying healthy for 6 to 9 years.At first, researchers believed that early treatment might allow a patient to stop taking ART after a period of controlling HIV. However, newer reports indicate that this is very unusual.
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The amount of HIV in the blood gets very high within a few days or weeks after HIV infection. Some people get a flu-like illness. This first stage of HIV disease is called "acute HIV infection" or "primary HIV infection."
About half of the people who get infected don?t notice anything. Symptoms generally occur within 2 to 4 weeks. The most common symptoms are fever, fatigue, and rash. Others include headache, swollen lymph glands, sore throat, feeling achy, nausea, vomiting, diarrhea, and night sweats.
It is easy to overlook the signs of acute HIV infection. They can be caused by several different illnesses. If you have any of these symptoms and if there is any chance that you were recently exposed to HIV, talk to your health care provider about getting tested for HIV.
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WHAT ACTIVITIES ARE MOST RISKY?
The highest risk of becoming infected with HIV is from sharing needles to inject drugs with someone who is infected with HIV. When you share needles, there is a very high probability that someone else's blood will be injected into your bloodstream. Hepatitis virus can also be transmitted by sharing needles.The next greatest risk for HIV infection is from unprotected sexual intercourse (without a condom). Receptive anal intercourse carries the highest risk. The lining of the rectum is very thin. It is damaged very easily during sexual activity. This makes it easier for HIV to enter the body. The "top" or active partner in anal intercourse seems to run a much lower risk. However, the risk still seems higher than for the active partner in insertive vaginal intercourse.
Receptive vaginal intercourse has the next highest risk. The lining of the vagina is stronger than in the rectum, but is vulnerable to infection. Also, it can be damaged by sexual activity. All it takes is a tiny scrape that can be too small to see. The risk of infection is increased if there is any inflammation or infection in the vagina.
The risk is higher for the receptive partner. However, there is some risk for the active partner in anal or vaginal sex. It's possible for HIV to enter the penis through any open sores, through the moist lining of the opening of the penis, or through the cells in the mucous membrane in the foreskin or the head of the penis.
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To spread HIV during sex, HIV infection in blood or sexual fluids must be transmitted to someone. Sexual fluids come from a man's penis or from a woman's vagina, before, during, or after orgasm. HIV can be transmitted when infected fluid gets into someone's body.
You can't spread HIV if there is no HIV infection. If you and your partners are not infected with HIV, there is no risk. An "undetectable viral load does NOT mean "no HIV infection." If there is no contact with blood or sexual fluids, there is no risk. HIV needs to get into the body for infection to occur.
Safer sex guidelines are ways to reduce the risk of spreading HIV during sexual activity.If you enjoyed this post, make sure you subscribe to my RSS feed! How can I get infected by HIV?
Unless you are 100% sure that you and the people you are with do not have HIV infection, you should take steps to prevent getting infected. People recently infected (within the past 2 or 3 months) are most likely to transmit HIV to others. This is when their viral load is the highest. In general, the risk of transmission is higher with higher viral loads. This fact sheet provides an overview of HIV prevention, and refers you to other fact sheets for more details on specific topics.
Sexual Activity
You can avoid any risk of HIV if you practice abstinence (not having sex). You also won't get infected if your penis, mouth, vagina or rectum doesn't touch anyone else's penis, mouth, vagina, or rectum. Safe activities include kissing, erotic massage, masturbation or hand jobs (mutual masturbation). There are no documented cases of HIV transmission through wet clothing.
Having sex in a monogamous (faithful) relationship is safe if:
* Both of you are uninfected (HIV-negative)
* You both have sex only with your partner
* Neither one of you gets exposed to HIV through drug use or other activities
Oral sex has a lower risk of infection than anal or vaginal sex, especially if there are no open sores or blood in the mouth. See Fact Sheet 152 for more information on the risks of various behaviors.
Some chemicals called spermicides can prevent pregnancy but they don't prevent HIV. They might even increase your risk of getting infected if they cause irritation or swelling.
Drug Use
If you're high on drugs, you might forget to use protection during sex. If you use someone else's equipment (needles, syringes, cookers, cotton or rinse water) you can get infected by tiny amounts of blood. The best way to avoid infection is to not use drugs.If you use drugs, you can prevent infection by not injecting them. If you do inject, don't share equipment. If you must share, clean equipment with bleach and water before every use.
Some communities have started exchange programs that give free, clean syringes to people so they won't need to share.
Vertical Transmission
With no treatment, about 25% of the babies of HIV-infected women would be born infected. The risk drops to about 4% if a woman takes AZT during pregnancy and delivery, and her newborn is given AZT. The risk is 2% or less if the mother is taking combination antiretroviral therapy (ART). Caesarean section deliveries probably don't reduce transmission risk if the mother's viral load is below 1000.Babies can get infected if they drink breast milk from an HIV-infected woman. Women with HIV should use baby formulas or breast milk from a woman who is not infected to feed their babies.
Contact with Blood
HIV is one of many diseases that can be transmitted by blood. Be careful if you are helping someone who is bleeding. If your work exposes you to blood, be sure to protect any cuts or open sores on your skin, as well as your eyes and mouth. Your employer should provide gloves, facemasks and other protective equipment, plus training about how to avoid diseases that are spread by blood.If you enjoyed this post, make sure you subscribe to my RSS feed! Is there a cure for AIDS?
There is no cure for AIDS. There are drugs that can slow down the HIV virus, and slow down the damage to your immune system. There is no way to "clear" the HIV out of your body.
Other drugs can prevent or treat opportunistic infections (OIs). In most cases, these drugs work very well. The newer, stronger ARVs have also helped reduce the rates of most OIs. A few OIs, however, are still very difficult to treat.If you enjoyed this post, make sure you subscribe to my RSS feed! HOW DO I KNOW IF I HAVE AIDS?
HIV disease becomes AIDS when your immune system is seriously damaged. If you have less than 200 CD4 cells or if your CD4 percentage is less than 14%, you have AIDS.
If you get an opportunistic infection, you have AIDS. There is an "official" list of these opportunistic infections put out by the Centers for Disease Control (CDC). The most common ones are:
- PCP (Pneumocystis pneumonia), a lung infection;
- KS (Kaposi's sarcoma), a skin cancer;
- CMV (Cytomegalovirus), an infection that usually affects the eyes
- Candida, a fungal infection that can cause thrush (a white film in your mouth) or infections in your throat or vagina
AIDS-related diseases also includes serious weight loss, brain tumors, and other health problems. Without treatment, these opportunistic infections can kill you.
The official (technical) CDC definition of AIDS is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm AIDS is different in every infected person. Some people die a few months after getting infected, while others live fairly normal lives for many years, even after they "officially" have AIDS. A few HIV-positive people stay healthy for many years even without taking antiretroviral medications (ARVs).If you enjoyed this post, make sure you subscribe to my RSS feed! WHAT HAPPENS IF I'M HIV POSITIVE?
The virus will multiply in your body for a few weeks or even months before your immune system responds. During this time, you won't test positive for HIV, but you can infect other people.
When your immune system responds, it starts to make antibodies. When this happens, you will test positive for HIV.
After the first flu-like symptoms, some people with HIV stay healthy for ten years or longer. But during this time, HIV is damaging your immune system.
One way to measure the damage to your immune system is to count your CD4 cells you have. These cells, also called "T-helper" cells, are an important part of the immune system. Healthy people have between 500 and 1,500 CD4 cells in a milliliter of blood.Without treatment, your CD4 cell count will most likely go down. You might start having signs of HIV disease like fevers, night sweats, diarrhea, or swollen lymph nodes. If you have HIV disease, these problems will last more than a few days, and probably continue for several weeks.
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HOW DO YOU GET AIDS?
You don't actually "get" AIDS. You might get infected with HIV, and later you might develop AIDS. You can get infected with HIV from anyone who's infected, even if they don't look sick and even if they haven't tested HIV-positive yet. The blood, vaginal fluid, semen, and breast milk of people infected with HIV has enough of the virus in it to infect other people. Most people get the HIV virus by:
- having sex with an infected person
- sharing a needle (shooting drugs) with someone who's infected
- being born when their mother is infected, or drinking the breast milk of an infected woman
Getting a transfusion of infected blood used to be a way people got AIDS, but now the blood supply is screened very carefully and the risk is extremely low.
There are no documented cases of HIV being transmitted by tears or saliva, but it is possible to be infected with HIV through oral sex or in rare cases through deep kissing, especially if you have open sores in your mouth or bleeding gums.
The Centers for Disease Control and Prevention (CDC) estimates that 1 to 1.2 million U.S. residents are living with HIV infection or AIDS; about a quarter of them do not know they have it. About 75 percent of the 40,000 new infections each year are in men, and about 25 percent in women. About half of the new infections are in Blacks, even though they make up only 12 percent of the US population.
In the mid-1990s, AIDS was a leading cause of death. However, newer treatments have cut the AIDS death rate significantly. For more information, see the US Government fact sheet at http://www.niaid.nih.gov/factsheets/aidsstat.htm.If you enjoyed this post, make sure you subscribe to my RSS feed! WHAT DOES "AIDS" MEAN?
- Acquired means you can get infected with it;
- Immune Deficiency means a weakness in the body's system that fights diseases.
- Syndrome means a group of health problems that make up a disease.
AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected with HIV, your body will try to fight the infection. It will make "antibodies," special molecules to fight HIV.
A blood test for HIV looks for these antibodies. If you have them in your blood, it means that you have HIV infection. People who have the HIV antibodies are called "HIV-Positive." Fact Sheet 102 has more information on HIV testing.
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If you have diabetes and have learned that you're pregnant, you'll experience all the emotions that come with having a baby but you'll probably also be concerned about the effect your diabetes could have on you and your child. Because of your diabetes, you'll have extra challenges to deal with during your pregnancy. The most important challenge is keeping your blood sugar under tight control, particularly before becoming pregnant and during the first eight weeks when your baby is developing. You should also:
- Check your medications. Tablets used to treat type 2 diabetes may harm your baby, so you may have to switch to insulin injections.
- Take a higher dose of folic acid tablets. Folic acid helps to prevent your baby from developing spinal cord problems. Doctors now recommend that all women planning to have a baby take folic acid. Women with diabetes are advised to take 5mg each day (only available on prescription).
- Have your eyes checked. Retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes. Pregnancy can place extra pressure on the small vessels in your eyes, so it’s important to treat retinopathy before you become pregnant.
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What's the alternative?
If you’ve been newly diagnosed with diabetes, it’s easy to worry about your sugar intake and forget everything else. “It’s important to be aware of the bigger picture,” says Diabetes UK dietician Natasha Marsland. “You need to limit sugar and sugary foods, but equally important is monitoring your fat intake and being aware of your overall diet.”
Try these alternatives:
- Avoid sugar with your tea and coffee. Sugar in liquid form raises blood glucose levels very fast, so if you can’t do without sugary drinks, try using intense sweeteners or experiment with herbal teas and diet drinks.
- Skip the chocolate biscuits when you’re peckish. Try oat-based biscuits as these take longer to be absorbed by the body. Some sweet biscuits, such as Garibaldi or rich tea are lower in fat than others.
- Instead of eating sweet puddings, try low-fat fruit-based yoghurts or eat fresh fruit salad with low-fat crème fraîche.
- Having diabetes doesn’t mean that you can’t eat crisps and dips. Try eating Quavers and Twiglets as they're lower in fat. Alternatively, home-popped corn (available from most supermarkets) can be sprinkled with a little sweetener, a small amount of salt, or paprika or celery salt. For dips, try salsa and reduced-fat dips.
- Don’t automatically reach for a chocolate bar to perk you up. Whizz up a smoothie using semi-skimmed milk, low-fat yoghurt and fruit.
- If a recipe calls for a large amount of cheese, use a stronger variety and you'll need less.
Losing weight
There are many benefits to losing weight. If you reach the ideal weight for your height, this will help to control your cholesterol level, blood pressure and blood glucose. You'll dramatically lower your risk of health problems, such as developing type 2 diabetes and heart disease, as well as increase your life expectancy. Being overweight can also make it harder to control your diabetes.
If you want or need to lose weight you should do it slowly and carefully, rather than crash dieting. You should never skip meals, as this can cause your sugar levels to fall quickly.
- Aim to do 30 minutes of activity (broken up if you prefer) at least five days a week.
- Swap your shoes for trainers on your way to work so you can walk up escalators and stairs, get off public transport a few stops earlier than you need to, or park your car a few blocks from the office and walk for 10 minutes.
- Leave your desk at lunchtime and take a stroll outside.
- Leave the car at home if your journey is less than a mile, always walk.
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There is no ‘special’ diet for people with diabetes. Along with the rest of the population, people with diabetes are advised to eat a healthy, balanced diet low in fat, sugar and salt and with plenty of fresh fruit and vegetables.
The trouble is, many people have different ideas of what a healthy diet really means and how it translates on a day-to-day basis. Can you eat bananas? Are you still allowed a slice of cake? Do you have to say no to wine at a friend’s birthday party? And what do you do if your favourite way of winding down after a long day is with a sugary cup of tea and a biscuit or two?
Dr Sarah Schenker, one of the UK’s leading dieticians, gives her top diabetes diet tips.
Eat plenty of starchy carbohydrates
- Choose carbohydrate foods that have a low glycaemic index (GI). Low GI foods release their energy slowly into the bloodstream and help to keep blood sugar levels more stable.
- Try not to eat too many high GI foods, especially between meals, as these foods can cause blood sugar levels to rise quickly.
Have regular meals and snacks
- Eat breakfast. By the morning, your body has been without food for many hours, and blood sugar levels can be low. Eating breakfast, such a bowl of wholegrain cereal or a toasted bagel with peanut butter, boosts your energy levels and sets you up for the day ahead.
- Eat healthy snacks between meals, such as yoghurts, fruit, low-fat cheese and crackers, vegetables sticks with a healthy dip.
- Don't skip meals.
Reduce your intake of unhealthy fats
- Add pulses, beans and lentils as a healthy alternative to meat when making stews, curries or casseroles.
- Choose low-fat dairy products, such as semi-skimmed milk and low-fat yoghurts.
- Always check labels on food, and avoid products that contain hydrogenated fats.
- Avoid fatty meats and meat products. Choose lean cuts of meat and remove visible fat and skin.
- Don't eat fried foods, fast foods and too many pastries, cakes, buns and biscuits.
Keep well hydrated and stick to alcohol guidelines
- Sip water and other healthy drinks throughout the day and carry a bottle of water with you wherever you go.
- Drink alcohol sensibly.
- Don’t let yourself get dehydrated. By the time you feel thirsty it’s too late; you’re already dehydrated.
- Don't overdo it. People with diabetes should be extra-careful not to binge drink, drink too quickly or drink on an empty stomach. If you do drink regularly, aim to have a few alcohol-free days each week.
Choose low GI foods
- apples
- pears
- peaches
- grapefruits
- plums
- cherries
- dried apricots
- mushrooms
- avocados
- leafy green vegetables
- lentils and beans
- soya products
- wholegrain pasta
- porridge and oatmeal
- wholegrain rye bread (including pumpernickel)
- brown rice
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You’ll be best equipped to manage your diabetes on a day-to-day basis if you’re given information and education when you’re diagnosed and then on an ongoing basis.
In 2001, the Department of Health published a national service framework for Diabetes. The purpose of this was to improve the standards of care for everyone with diabetes. The national service framework says that people with diabetes should have information and education to help them self care.
What is structured patient education?
Structured patient education means that there's a planned course that:
- covers all aspects of diabetes,
- is flexible in content,
- is relevant to a person’s clinical and psychological needs, and
- is adaptable to a person’s educational and cultural background.
How do I know if I am receiving good structured education?
The Department of Health together with Diabetes UK set up a group to support good structured education. The group has developed some guidance and published a report so that you can judge whether the education you're getting about your diabetes is of a high standard. If you're not sure, you should ask your diabetes team.
A good planned education course should:
- Provide a written outline, so that you can see what will be taught on the course.
- Be delivered by trained educators. As a minimum the course should be given by someone who understands the principles of patient education and has been assessed as competent to teach the programme.
- Be quality assured to make sure it's of a consistently high standard.
- Provide the opportunity for feedback to show that it's making a difference to the people who go on it.
What course should I go on?
You need to go on a course that meets your needs and will support you. Different courses will suit different people, depending on things such as what type of diabetes they have, and how long they have had it.
- Courses should reflect established methods of adult learning and the curriculum should be clearly written down.
- Courses should be run by appropriately trained professionals from a variety of backgrounds (such as nurses and dietitians) to groups of people with diabetes, unless group work is considered unsuitable for an individual.
- Sessions should be accessible to the broadest range of people, taking into account the person’s culture, ethnicity, any disability they might have and where they live.
- Sessions should be held locally, for instance in a community setting or local diabetes centre.
- Courses should use a variety of teaching styles to promote active learning, where everyone gets involved and can relate what they're learning to their own experiences.
- Courses should be adapted to meet the different needs, personal choices and learning styles of people with diabetes.
- Education should become part of your normal diabetes care.
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If your diabetes isn't treated, it can lead to many different health problems. Large amounts of glucose can damage blood vessels, nerves and organs, and even a mildly raised glucose level that doesn't cause any symptoms can have damaging effects in the long term.
Heart disease and stroke
If you have diabetes, you're up to five times more likely to suffer heart disease and stroke compared with people without diabetes. Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis (furring up and narrowing of the blood vessels). This may result in poor blood supply to the heart, causing angina. It also increases the chance that a blood vessel in your heart or brain will become completely blocked, causing a heart attack or stroke.
Retinopathy (damage to the retina at the back of the eye)
Blood vessels in the retina of your eye can become blocked, leaky or grow haphazardly. This damage gets in the way of the light passing through to your retina and, if left untreated, can damage vision.
The better you control your blood sugar levels, the less chance you have of serious eye problems. Having an annual eye check by a specialist (an ophthalmologist or an optometrist) can help to pick up signs of any potentially serious eye problems early on, so that they can be treated. However, if you've got eye problems, the Royal National Institute of the Blind (RNIB) offers this advice:
- Don't wait until your vision has deteriorated to have an eye test.
Most sight-threatening diabetic problems can be managed by laser treatment if it's given early enough. - Don't be afraid to ask questions or express concerns about your treatment.
Good sugar, blood pressure and cholesterol control reduces the risk of diabetes-related sight loss. - Attend your diabetic clinic or GP surgery for regular diabetes health checks, including blood pressure and cholesterol monitoring.
- Smoking increases your risk of diabetes-related sight loss. Your doctor can tell you about NHS stop smoking services in your area.
- The National Diabetic Retinopathy Screening Programme will arrange for you to have your eyes checked every year. From December 2007, everyone on a diabetes register will be offered the opportunity to have a digital picture taken of the back of their eye. To register, speak to your GP.
Diabetic retinopathy can be managed by laser treatment if it's caught early enough. It's important to realise, however, that this will only preserve the sight you have, not make it better. More information about the laser treatment is available from the RNIB.
Foot problems
Damage to the nerves of the foot can mean that small nicks and cuts are not noticed, leading to the development of a foot ulcer. About one in 10 people with diabetes get foot ulcers, which can cause serious infection.
Check your feet every day and report any changes to your doctor, nurse or podiatrist. Danger signs to look out for include sores and cuts that don’t heal, puffiness or swelling and skin that feels hot to the touch. You should also have a foot examination at least once a year.
Podiatry/chiropody (the treatment of abnormalities and conditions of the foot and lower limbs) is usually available on the NHS free of charge. People with diabetes are treated as priority cases, but you'll need a referral from your GP, practise nurse or health visitor. Ask them whether the treatment is available in your area. If it is, your case will be assessed and you'll be added to a waiting list and will receive a letter telling you when your appointment is. If needed, it may be possible to arrange home visits.
If free NHS treatment is not available in your area, you can go to a local clinic for private treatment, but you'll have to pay.
Miscarriage and stillbirth
Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If their blood-sugar level is not carefully controlled in the early stages of pregnancy there is also an increased risk of the baby developing a serious birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or in a diabetic clinic, where doctors can keep a close watch on their blood-sugar levels and control their insulin dosage more easily.
Kidney disease
The small blood vessels of the kidney become blocked and leaky, making the kidneys work less efficiently.
Damage to the nerves and blood vessels can lead to erection problems in men. This may be treated with medication. This is more common in men who smoke.
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Diabetes is a condition that's with you for life. You'll need to learn to plan your life, and your clinic will help with a care plan. Don’t underestimate the psychological effects of your diagnosis. In some parts of the country, there are focused courses, some called DAFNE, others called DESMOND. Ask at your clinic for availability.
Type 1 diabetes
If you have type 1 diabetes, you'll need to have regular insulin injections for the rest of your life to keep your glucose levels normal. Insulin injections can be administered using a syringe or an injection pen. Most people need between two and four injections a day, sometimes more. Your GP or diabetes nurse will teach you and/or a friend or relative how to inject the insulin properly.
An alternative to injecting insulin is insulin pump therapy. An insulin pump is a small device – about the same size as a pack of cards – that holds the insulin. The pump is attached to a long piece of thin tubing with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but the hips, thighs, buttocks or arms can also be used. The pump allows insulin to flow into your bloodstream at a rate that you can control. This means you no longer need to give yourself injections.
Another alternative now available on the NHS is a new device for delivering insulin without using a needle. Known as the insulin jet system, it can be used on the stomach, buttocks and thighs. It works by forcing a very small stream of insulin through a nozzle placed against the skin. The insulin travels at such high speed it goes through the skin.
You'll need to regularly check your glucose levels. This can be done at home using a simple finger prick blood test. Your ideal glucose blood level is between four and seven millimoles per litre (mmol/l) before meals, and less than 10 mmol/l two hours after meals. Mmol/l is used to define the concentration of glucose in the blood.
Find out how to test your glucose levels (opens in new window)
Type 2 diabetes
You can control type 2 diabetes by making changes to your diet, losing weight if you're overweight, and taking regular exercise. Most people with type 2 diabetes need to take tablets; some also have insulin injections.
There are several different types of medicines used to treat type 2 diabetes:
* Metformin
This is often the first medicine that is advised for type 2 diabetes. It works by reducing the amount of glucose that the liver releases into the bloodstream. One in five people get diarrhoea from metformin. If this happens to you, you must stop taking it and see your doctor.
* Sulphonylureas
These increase the amount of insulin produced by the pancreas. Also, they make the body’s cells more sensitive to insulin so that more glucose is taken up from the blood.
* Acarbose
This slows down the absorption of carbohydrate from the stomach and digestive tract, preventing a high peak in the blood glucose level after eating a meal. There can be side effects such as increased flatulence (wind), rumbling stomach, a feeling of fullness, tummy pain, diarrhoea (particularly after a meal containing sugar or sucrose-containing foods), constipation, skin rash, jaundice (yellowing of the skin and whites of the eyes) and swelling. Speak with your doctor if any of these symptoms continue or become troublesome.
* Thiazolidinediones (glitazones)
These make the body’s cells more sensitive to insulin so that more glucose is taken up from the blood. They aren't usually used alone, but can be taken in addition to metformin and a sulphonylurea.
* Nateglinide and repaglinide
These stimulate the release of insulin by the pancreas. They're not commonly used, but are an option if other medicines don't control the blood glucose levels.
It might be necessary to take a combination of two or more of these medicines to control your blood glucose level.
Other treatments
If you have type 1 or type 2 diabetes, you're at risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:
* Anti-hypertensive medicines to control high blood pressure.
* A statin to reduce high cholesterol levels.
* Low dose aspirin to prevent stroke.
* An Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) if you have the early signs of diabetic kidney disease. This is identified by the presence of small amounts of albumin (a protein) in the urine and is often reversible if treated early enough.
* Many people with type 2 diabetes also have heart disease and may need treatment for it – for example, they may be prescribed Alpha-2 blockers.
You should also have a flu vaccination each year and a one-off pneumococcal vaccine, as these infections can be particularly unpleasant and more serious if you have diabetes.
If you enjoyed this post, make sure you subscribe to my RSS feed! Symptoms of diabetes
- feeling very thirsty,
- producing excessive amounts of urine (going to the toilet a lot),
- tiredness, and
- weight loss and muscle wasting (loss of muscle bulk).
Other symptoms can include:
- itchiness around the vagina or penis, or getting thrush regularly, due to the excess sugar in your urine encouraging infections, and
- blurred vision, caused by the lens of your eye becoming very dry.
Symptoms of type 1 diabetes can develop quickly, over weeks or even days.
If your blood glucose levels become too high, you can suffer from hyperglycemia. This can happen if you haven’t taken your insulin, or if you’re ill. The symptoms of hyperglycaemia can include dehydration, drowsiness and a frequent need to urinate. If left untreated, hyperglycaemia can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death. Diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build up of ketone acids in your blood.
If your glucose levels become too low, you can suffer a hypoglycaemic attack. This can happen if you have taken too much insulin or if you've exercised a lot. Symptoms of a ‘hypo’ include feeling shaky and irritable and can be managed by eating or drinking something containing fast-acting carbohydrates, such as a sugary drink or sugar cubes.
Symptoms of type 2 diabetes usually develop over weeks or months. Some people with type 2 diabetes have few symptoms or even no symptoms at all. But the condition mustn’t be ignored, otherwise other health problems could develop.If you enjoyed this post, make sure you subscribe to my RSS feed! Important querries about diabetes
More than two million people in the UK live with diabetes and another 750,000 people have diabetes but don’t know it. Type 1 and type 2 are the most common types of diabetes. Both are serious conditions, caused by too much glucose in your blood, which can damage your health if they're ignored or aren't treated properly.
We asked Grace Vanterpool, a diabetes consultant nurse at Hammersmith and Fulham Primary Care Trust, what she would want to know if she was diagnosed with diabetes.
Will I need injections?
The main aim of diabetes management is to keep blood glucose levels as near normal as possible. Insulin is the hormone that helps glucose from food move into your body's cells where it's used as energy. People with type 1 diabetes have no insulin in their bodies and will need insulin injections.Your doctor will put you in touch with your diabetes nurse who will teach you and assist whenever necessary. People with type 2 diabetes don't produce enough insulin, so a healthy diet will help them manage their condition. However, because the condition is progressive, people with type 2 diabetes may eventually need various tablets and possibly insulin.
Will I have to give up sugar?
What you eat directly affects the level of glucose, fat and salt in your blood. You'll need to cut down on sugar and sugary foods because these directly affect your blood glucose levels. By choosing a healthier diet that’s high in fibre, fruit and vegetables, and low in sugar, fat and salt, you can reduce your chance of developing complications.
You don’t need to buy special diabetic food. When you're newly diagnosed, you'll be referred to a dietitian. By sticking to your management plan, monitoring your condition and following a healthy lifestyle, you should be able continue with all the daily activities that you enjoy.
Are there foods that will be beneficial to me?
Eat regular meals based on carbohydrates. Foods such as bread, potatoes and rice will help to control your glucose levels. All varieties are fine, but wholegrain ones are best of all.
Can I still drink alcohol?
Yes, but in moderation. According to national guidelines, that means no more than 21 units of alcohol a week for men and no more than 14 units for women.
Is my weight a factor in coping with my diabetes?
If you're overweight, losing weight will help control your diabetes. Aim to lose 0.4-0.9kg (1-2lbs) a week. Try to cut down on fat. Choose low-fat dairy products and lean cuts of meat. Use low-fat cooking methods, such as grilling and baking, and skim all the fat from casseroles, stews and curries. Choose mono-unsaturated oils, such as olive oil or rapeseed oil, and aim for at least five portions of fruit and vegetables a day. They’re low in fat and calories and are a good source of vitamins and minerals.
How important is exercise?
Physical activity is just as important as healthy eating so make it part of your management plan. Exercise helps to regulate blood glucose levels. It also helps your insulin (the hormone that regulates the body’s metabolism) work more effectively, reduces your weight, improves your blood cholesterol and helps to prevent heart disease. Do a physical activity that makes you feel a little out of breath, but so you can still talk, for at least 30 minutes each day.
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What is diabetes?
Diabetes mellitus is a chronic condition caused by too much glucose in your blood. Your blood sugar level can be too high if your body doesn't make enough of the hormone insulin. Insulin is produced by the pancreas (a gland behind the stomach) and moves glucose out of the blood and into cells, where it's broken down to produce energy.
If diabetes is not treated, it can cause long-term health problems because the high glucose levels in the blood damage the blood vessels.
Type 1 or insulin-dependent diabetes
In type 1 diabetes the body produces little or no insulin. Someone with this type of diabetes needs treatment for the rest of their life. They must check the levels of glucose in their blood regularly and watch out for complications. Type 1 diabetes is also known as juvenile diabetes or early onset diabetes because it usually develops before the age of 40, often in the teenage years.
You're more at risk of type 1 diabetes if it runs in your family.
Type 2 or non-insulin dependent diabetes
Nine out of 10 people with diabetes have type 2 diabetes, which means their body doesn't make enough insulin or cannot use insulin properly. Type 2 diabetes used to be referred to as maturity onset diabetes because it occurs mostly in people over the age of 40.
Type 2 diabetes is closely linked to obesity. You're also more at risk of developing type 2 diabetes if:
- you have high blood pressure or high cholesterol,
- type 2 diabetes runs in your family,
- you're of Asian, Afro-Caribbean or Middle-Eastern background, or
- you're a woman who has given birth to a large baby (over 9 lbs/4 kg).
The risk of developing type 2 diabetes also increases as you get older.
Gestational diabetes
Some pregnant women have such high levels of glucose in their blood that their body cannot produce enough insulin to absorb it all. This is known as gestational diabetes or diabetes in pregnancy. It affects less than one in 20 pregnant women. Gestational diabetes usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life. The Diabetes UK website has more information about gestational diabetes.
Pre-diabetes
Pre-diabetes occurs when blood glucose levels exceed normal levels, but don't climb high enough to warrant a diagnosis of diabetes. If pre-diabetes is left untreated it may develop into type 2 diabetes.
It could be possible to prevent the development of type 2 diabetes if you find out about your pre-diabetes early enough. Adjustments to diet and exercise can prevent the onset of type 2 diabetes by almost 60%. Reducing your weight by 10%, and taking part in modest physical activity for 30 minutes daily, could also reduce your risk.
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