Liesl Richardson, Senior Diabetes Specialist Nurse from The Norfolk and Norwich University Hospital

Liesl Richardson, Senior Diabetes Specialist Nurse from The Norfolk and Norwich University Hospital

On Thursday 28th May Liesl started her presentation by reviewing the symptoms of diabetes and the problems that ensue if it is not diagnosed and she also considered its causes. For those with Type 1 Diabetes- that is those whose insulin producing beta cells in the Islets of Langerhans within the pancreas have been lost to an attack by their body’s own immune system – Liesl advised that she runs the DAFNE (dose adjustment for normal eating) courses at the N&N.U.H that guide Type 1s in adjusting their required dose of insulin in relation to their carb (carbohydrate) intake. Access to these courses can be requested through the diabetic patient’s doctor. From her experience of diabetics though Liesl recognised the problems diabetics may have in managing their somewhat complex treatment when faced with other concerns in their lives.

For Type 2s that is those whose insulin production is progressively reducing over time, extra body fat is an aggravating factor since it blocks the action of insulin and makes matters worse. For the many Type 2s who are not overweight, are active, have a healthy diet and take exercise, Liesl discussed in more detail dietary issues and currently used medications drawing on her now very considerable experience of diabetics and their concerns and treatment.

One of her particular missions is to make much better known the often-unrecognised effect of poor blood sugar control on pregnancy as it can seriously damage the foetus as well as the pregnant mother.

The body breaks down carbohydrates into glucose (a simple sugar) that is delivered by insulin to cells to provide energy. Insulin along with other hormones from the pancreas automatically provides the right amount of glucose/energy to cells but without insulin the sugars quickly rise to high levels in the blood. Diabetics can moderate these peaks for example, by their consuming foods with more complex long chain carbohydrates that are slower to breakdown, i.e. those with a low glycaemic index (GI) rating, such as oats. Vegetables (other than potatoes and sweet corn) and fruit are similarly valued for diabetics since though fruit contains the simple fruit sugar (fructose) this has to be extracted in digestion from the mass of the fruit. Fruit juices on their own, without any buffering, will give a peak, but they can have a good use in that for those at risk of hypos (dangerously low blood sugars) they can quickly assist recovery.

Excessive levels of blood sugar will over time lead to many medical complications, from minor effects such as a less elastic skin to much more serious conditions such as cardiovascular disease, kidney failure or premature blindness. This makes the annual medical check very vital and aside to having a full blood test, it is important to take a urine sample along as well so that kidney function can be checked. For eyes, the N&N.U.H has a mobile retinal screening service that does the rounds of all Norfolk surgeries so that any capillary failure is picked up at an early and treatable stage. Interestingly this mobile service was pioneered by the N&N.U.H and from this a nationwide service developed.

Liesl’s last message was that unlike in the past when complications were more common, well-managed diabetes with good diet and exercise can give diabetics a long and healthy life.