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According to the report "Diabetes in the UK 2010" since 1996, the number of people diagnoses with diabetes in the UK has increased from 1.4 million to 2.6 million.

So what is diabetes? Diabetes mellitus is a disease caused by a deficiency of insulin. There are two main types of diabetes which are: Type 1 Diabetes which results from the body failure to produce enough insulin.

Type 2 diabetes which results in a resistance to insulin.

Type 1 Diabetes is believed to have a number of possible factors including genetic predisposition and an auto immune reaction. Type 1 diabetics usually are dependent upon insulin.

Type 2 Diabetes has traditionally been thought of as a late onset disease although it is increasingly affecting young children.

If you are pregnant when booking the midwife should check your risk factors which are:

Having a first degree relative with Type 2 Diabetes such as a parent, brother, sister or child;

Being overweight or obese;

Having a waist measuring more than 80 cms if you are a woman and 94 cms if you are a man;

Having impaired glucose tolerance; and

Having diabetes or impaired glucose tolerance when you are pregnant.

Symptoms of diabetes include passing large amounts of urine, being tired and weight loss.

According to the World Health Organisations diabetes is diagnosed by a high blood glucose level and symptoms or two high blood glucose levels with no symptoms symptoms. The diagnosis cannot be made on reagent stick testing.

It is important to distinguish between Type 1 Diabetes and Type 2 Diabetes as if Type 1 diabetes is suspected urgent referral treatment is needed. With Type 2 diabetes referral is not so urgent.

Type 2 diabetes can be treated in the first instance by weight control and physical activity followed by, if none of these measures work, tablets to reduce the blood glucose level. In some cases insulin injections are needed. If diabetes is not diagnosed or treated properly, sufferers can become extremely ill with dehydration, drowsiness and serious illness which can be life threatening.

Chronic complications include:

hardening of the arteries (also known as atheroma) which can cause problems such as angina, heart attacks, stroke and poor circulation.

kidney damage.

eye problems.

nerve damage.

foot problems.

GPs should provide regular foot checks to identify problems of ulceration and foot ischemia can be dealt with by the GP. However, if the start of ischemia (in this case restriction of flow of blood to the foot is suspected, this should be dealt with as an emergency.

NICE (The National Institue Of Health And Clinical Excellence) Guidelines require that if a foot care emergency arises (ie new ulcer or swelling or discolouration) this should be referred to a multi disciplinary diabetic care team to be reviewed within 24 hours which must investigate and treat vascular insufficiency and use antibiotics for active infection.

If acute ischemia is suspected, the patient should be referred immediately to a vascular surgical unit ie by direct telephone contact with a senior member of the surgical team or blue light ambulance to accident and emergency.

NICE guidelines recommend that all diabetics undergo an annual review by trained staff. So far as diabetic retinopathy (damage to the blood vesseles in the retina caused by diabetes) is concerned, all diabetic should be offered annual screening. Delay in identifying and treating diabetic retinopathy can cause visual loss.

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