Liesl Richardson, 24th March 2016

Liesl Richardson, 24th March 2016

Liesl Richardson, Senior Diabetes Specialist Nurse at the Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital.

For diabetics their lifelong, changing and complex illness continually raises a host of questions about its management, but modern pressures on the NHS means there is not time on surgery visits for lengthy discussions. Thus to have a specialist like Liesl with extensive experience of diabetes and diabetics, and  a mass of detailed information at her fingertips is a heaven sent opportunity for many members with diabetes to gain answers to their worries.

Liesl happily was pleased to discuss a wide range of topics with members starting with diet and the somewhat misleading claims in the press that extreme dieting, such as with the Newcastle diet, can ‘cure’ diabetes. Where weight loss is a requirement this diet has a value, but should only ever be undertaken in consultation with their diabetes medical practitioner, particularly for the post-diet transitional period.

The discussions on the structure of carbohydrates and the rate at which simple and more complex glucose chains are absorbed was revealing and led on to further consideration of GI values.

Liesl emphasised that for those on insulin, and also those taking tablets like gliclazide (sulphonylureas), hypos are a serious very issue and the figure to be born in mind when calculating recovery treatment is that 10 grams of carbohydrate equals 3mmol/l of blood glucose. Overnight the liver releases glucose to keep all the body’s systems operational. At bedtime blood sugars should ideally be at 7mmol/l since between 1-2am insulin sensitivity is high, but towards day-break cortisol is released in readiness for the body becoming active. In some diabetics this gives rise to the ‘dawn phenomenon’ which indicates high blood sugar problems. And with such complex processes Liesl further advised that a 3am test is required to determine what is happening and to adjust as necessary the earlier insulin and carbohydrate intake. The required HbA1c figure of 48mmol/mol (6.5%) can, by averaging sometimes mask such anomalies.

With the new DVLA requirement for those on insulin to test before driving and every two hours whilst driving, it has become even more important to fully understand hypos. Lisa explained that as blood sugars approach 4mmol/l several physical symptoms (neurogenic) such as shaking, pounding heart, anxiety, tingling etc. should be noticed, and below that more serious and dangerous  neuroglycopenic symptoms will arise including confusion, visual problems, aggression, lack of coordination and mood deterioration. Without intervention by taking quickly absorbed carbs blood glucose will continue to drop in diabetics to the point of physical collapse. Additionally frequent low glucose episodes can habituate the brain and thus reduce future warning signs.

In non-diabetics the body does not allow blood glucose to drop below 3.5 and keeps it under 7.8.

All those present at the meeting expressed their considerable gratitude to Liesl for her advice that will help to improve their understanding and management of diabetes.