In the UK, it is usually the general practitioner who initially suspects, identifies or diagnoses diabetes. As noted earlier, the patient may have come to see the doctor with marked symptoms that indicate the condition. However, it is quite common for diabetes to come to light incidentally, during the course of some other medical examination or check-up. Usually, a urine sample will have been tested (by means of a stick that changes colour in the presence of glucose) and a positive result will have prompted the doctor to look for other signs of diabetes. Glycosuria is not in itself diagnostic of diabetes, and, even more important, its absence at a particular moment does not necessarily mean that there is no diabetes. Several factors can influence glycosuria, including certain drug treatments, fluid intake and urine concentration and, most significantly, the person's renal threshold for glucose. The renal threshold is the level or concentration at which glucose is reabsorbed into the body during the process of filtration in the kidneys. Those with a low renal threshold, notably children in normal health, are hence much more likely to show glycosuria. Conversely, elderly people are far more likely to have a high renal threshold and glycosuria may be absent even in the presence of diabetes. This is why it is usual for a finger prick test for blood glucose (similar to that used for self-monitoring in established diabetes) to be carried out. If results indicate the likelihood of diabetes, a telephone referral is made to the local diabetes clinic which often operates from the nearest hospital. If the situation is urgent - the person has serious osmotic symptoms or ketonuria, feels ill, or is judged to be at risk of acute metabolic complications - arrangements are made for emergency admittance to hospital. If the person is not at risk, the appointment to attend the diabetes clinic will be as soon as possible. Those with Type 1 diabetes have the greatest priority and will usually be seen immediately. Staff at a typical hospital-based diabetes clinic usually include the following:
- consultant diabetologist (a specialist in diabetes)
- specialist diabetes nurses (Specialist nurses are highly trained in all aspects of diabetes care including patient education, administering and monitoring of treatment and alteration of doses, management of all aspects of diabetes and its complications on a long-term basis, and referral to specialists when required. The nurse is the person with whom the patient has most contact and he or she may also undertake home visits and community-based care.)
- dietitian
- podiatrist (specialist in foot care).
Diabetic patients may also require the help of other specialists from time to time, especially in connection with the complications of their condition. These may include:
- cardiologist (heart specialist)
- vascular surgeon (specialist in diseased and damaged blood vessels)
- nephrologist (specialist in kidney disease)
- ophthalmologist (eye specialist).
Living with diabetes can have a considerable psychological impact and there is a higher than normal risk of depression. Some people benefit from psychological counselling, and staff at the diabetes clinic are able to make referrals to a psychologist/psychotherapist, when this is considered to be helpful or necessary.
You can read also about: Management of Diabete
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