20th October 2023
This is the third in my series of three blogs about diabetes: it focuses on the increase of risk
of CVD for people with diabetes. The following quote from Diabetes UK paints a stark picture
of the current situation in the UK:
‘Every week, we estimate, diabetes is a cause in over 590 heart attacks and 770 strokes in the
UK’ (www.diabetes.org.uk, 2023).
CVD and Type 1 Diabetes:
CVD is a major cause of death for people with both Type 1 (T1) and Type 2 (T2) diabetes,
reducing life expectancy by at least 11 years. I have talked about T2 in earlier blogs so here I
want to focus on T1, where onset of CVD happens at an earlier age and is more pronounced
than the general population. The risk remains significant even in those people whose diabetes
is well managed. In fact, CVD is the most frequent cause of death for people with T1.
Less than 1 in 10 people in the UK with diabetes have T1. The exact causes are unknown and
there is currently nothing an individual can do to prevent T1 diabetes from developing. Most
people are diagnosed in childhood, however T1 diabetes can develop at any age. There is a
slightly higher risk of developing it if your parents or siblings have it.
What’s behind Type 1?
So, what causes T1 diabetes? The condition occurs when insulin producing beta cells in the
pancreas are destroyed by the person’s immune system. Therefore, the required insulin
needed to live cannot be produced.
Researchers are currently working to find ways to disrupt the process of someone’s immune
system attacking their beta cells. The overall aim of the research is to find a way to prevent
people from developing T1.
What are the current treatments?
For adults (people aged over 18) in England and Wales NICE guidelines state that they should
be offered a choice of a CGM (Continuous Glucose Monitoring) insulin pump or flash glucose
monitor (Freestyle Libre). People with T1 who are pregnant should be offered CGM. In
Scotland, the recommendation is that people with T1 should be offered a Freestyle Libre
monitor; with CGM offered only during pregnancy.
The four Ts
Asking the right questions at the right time can help identify whether someone has T1
diabetes. The key questions are:
Are you going for a wee more often especially at night?
Are you constantly thirsty?
Are you tired and have no energy?
Are you losing weight unintentionally?
Diabetes UK calls this the 4Ts – Toilet, Thirsty, Tired and Thinner. If it is left undiagnosed T1 can
be fatal, resulting in diabetic ketoacidosis.
Delivery has an impact
Being diagnosed as having diabetes is quite frightening. Therefore as a healthcare
professional, it is important to pace what you say and how you say it. Simply thinking about
this and being aware can make a difference to whether people feel empowered or
disempowered by their diagnosis – it is after all life changing. Time is also needed to explain
the facts and help people overcome their fears. I often hear people say, ‘the doctor just told
me very bluntly that I had diabetes, I was in shock and didn’t hear anything else’.
A knowledge of health coaching can support HCPs when having these conversations, enabling
you to coach patients based on their specific needs. We offer a package of health coaching
and clinical upskilling with one of our partners, Peak Health Coaching. Find out more about the
package here. I also recommend that practitioners regularly visit the Diabetes UK website for up to
date information on prevention, treatment and management.