Your questions answered

Q. Does eating too many sweet things give you diabetes?

A. No, a person cannot get diabetes from eating too many sweet things. However, being very overweight or obese is a risk factor for developing type 2 diabetes, and having too many high-calorie, sugar-laden foods in your diet increases the likelihood that you will gain weight.

In addition, having a close relative with diabetes increases your risk of developing the condition yourself, and obesityExcess accumulation of fat in the body. and physical inactivity further increase this risk in people who are already genetically susceptible.

Q. If you have an urge to eat sweet things does that indicate diabetes?

A. No. Having an urge to eat sweet things is not a symptom of diabetes. Key symptoms to watch out for include needing to urinate often, being excessively thirsty or feeling generally tired.

An intense hunger can also signal diabetes, although this may not necessarily be for sweet foods. While all of these symptoms may be quite noticeable in type 1 diabetes, often people with type 2 diabetes may not notice any symptoms at all.

Q. Is diabetes infectious or contagious?

A. No. You cannot catch diabetes from another person, nor is there any risk of passing it to another person if you yourself suffer from diabetes.

However, having diabetes seems to impair your body's ability to fight infectionInvasion by organisms that may be harmful, for example bacteria or parasites., so you are more at risk of a variety of other problems including vaginal Candida ('thrush'), wound infections and foot infections.

Q. I've heard that lifestyle factors can increase a person's risk for diabetes: is it my fault if I have diabetes?

A. It is thought that diabetes is caused by a combination of geneticRelating to the genes, the basic units of genetic material. and environmental factors. If you have a close relative with diabetes, you are more likely to develop the condition yourself. Certain environmental factors such as obesityExcess accumulation of fat in the body. will increase this risk, especially in genetically susceptible people.

While you cannot change your geneticRelating to the genes, the basic units of genetic material. make-up, there are influences involved in the development of diabetes that you can control.

Being overweight or obese and having a sedentary lifestyle can markedly increase the risk of type 2 diabetes. Escalating rates of obesityExcess accumulation of fat in the body. in many countries are thought to be at least partly responsible for this type of diabetes becoming more common.

Eating a healthy diet, avoiding weight gain and taking regular physical activity significantly reduce the risk of both obesityExcess accumulation of fat in the body. and type 2 diabetes.

Once you have been diagnosed with diabetes, it is important not to blame yourself but to focus on the steps that you can take to lead an active and healthy lifestyle. This will help to ensure that your diabetes is well controlled and will also help to prevent the development of any complications.

See the page on diet and diabetes.

Q. Why does my doctor say that I need to lose weight?

A. Being overweight or obese is very closely linked to insulin resistanceA reduced response of the body to the hormone insulin, resulting in raised blood glucose levels., a condition in which the body cannot respond properly to the actions of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. Insulin resistanceThe ability of a microbe, such as a type of bacteria, to resist the effects of antibiotics or other drugs. [link to core copy] is the key underlying problem in type 2 diabetes in particular. This means that losing weight is likely to improve your diabetes and help your body to maintain normal glucoseA simple sugar that is an important source of energy in the body. levels.

In addition, being overweight increases the risk of other conditions such as cardiovascular disease. People with diabetes already have an increased risk of cardiovascular disease, which usually develops at a younger age than it does in people who do not have diabetes.

If you are overweight you will improve your condition and reduce your risk of associated diseases if you take steps to get back to a healthy weight by modifying your diet and exercising regularly.

Q. I have just been diagnosed with type 2 diabetes and my friend says that I can manage it by just watching what I eat - is that true?

A. Some people with type 2 diabetes can manage their condition through diet and exercise alone, especially in the early stages. This is not true of everyone, however.

Most people with type 2 diabetes will need some form of anti-diabetic medication to help them to control their bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels. This is likely to be in tablet form, at least initially, although some people with type 2 diabetes may eventually need insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. injections.[1]

Learn more about the treatment of diabetes.

Q. What are pre-diabetes and metabolic syndrome?

A. Pre-diabetes is a condition in which glucoseA simple sugar that is an important source of energy in the body. levels are higher than the normal range, but not high enough to be classed as diabetes - as defined by the World Health Organization.[2]

The causes of and risk factors for pre-diabetes appear to be the same as those for type 2 diabetes. The interest in pre-diabetes lies in the belief that if people with pre-diabetes make significant changes to their lifestyle, they may be able to prevent the condition progressing to type 2 diabetes.

Metabolic syndrome is a cluster of risk factors for cardiovascular disease that includes either diabetes or pre-diabetes, along with abdominal obesityObesity centred around the abdomen, resulting in a high waist circumference., high blood pressure and disordered levels of lipids in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid..[3, 4]

Again, intensive lifestyle intervention may prevent or delay the progression from metabolic syndromeThe combination of insulin resistance, abdominal obesity, high blood pressure and disordered blood lipids that increases the risk of cardiovascular disease. to more serious disease. Treatment of the individual components of metabolic syndromeThe combination of insulin resistance, abdominal obesity, high blood pressure and disordered blood lipids that increases the risk of cardiovascular disease. may avert the potential consequences.

Q. Can diabetes be cured?

A. Recent research has indicated that surgical procedures specifically designed to help a person lose weight may be able to cure type 2 diabetes in many patients. These procedures are known as bariatric surgery [link to feature on bariatric surgery]. One study suggested that up to four-fifths of people with type 2 diabetes who underwent bariatric surgery found that their condition resolved.[5]

This is because obesityExcess accumulation of fat in the body. is closely linked to insulin resistanceA reduced response of the body to the hormone insulin, resulting in raised blood glucose levels., a condition in which the body fails to respond properly to the actions of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. Insulin resistanceThe ability of a microbe, such as a type of bacteria, to resist the effects of antibiotics or other drugs., in turn, is the key factor underlying type 2 diabetes.

Pancreatic transplantation is a newer treatment option for type 1 diabetes.[6] This involves transplanting either the whole pancreas, or just the parts of the pancreas that produce insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. - the pancreaticRelating to the pancreas. islets.

While these procedures can achieve long-term glucoseA simple sugar that is an important source of energy in the body. control without the need for drug therapy, however, many would argue that they are not a cure. In time, the function of the transplanted pancreaticRelating to the pancreas. tissue may decline, so that insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. therapy is needed again.

It is important to note, also, that neither bariatric surgery nor pancreaticRelating to the pancreas. transplantation is without risk. These procedures carry a significant risk of surgical complications. They are by no means suitable for everyone. It is best to speak with your healthcare team if you have any questions.

Q. Will having diabetes shorten my life?

A. Not if it is well controlled. The main concern for people with diabetes is the long-term development of complications due to poor glucoseA simple sugar that is an important source of energy in the body. control - in particular, cardiovascular disease.

People who have diabetes that is not well controlled tend to develop cardiovascular disease at a younger age than others.

The good news, though, is that these complications are largely preventable. Good glucoseA simple sugar that is an important source of energy in the body. control - keeping bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-sugar levels as close as possible to normal - reduces the risk of developing diabetic complications. The better the glucoseA simple sugar that is an important source of energy in the body. control, the lower the risk.[7]

Q. I have type 2 diabetes. Is it true that my risk of heart disease is increased? Can it lead to any other diseases?

A. Yes. Having type 2 diabetes can increase your risk of heart disease, especially if your diabetes is not well controlled. Furthermore, you are at risk of developing heart disease at a younger age than other people. This is one of the key concerns for people with diabetes.

Other conditions may be associated with diabetes as well, including foot ulcers and problems with vision. Fortunately, these risks can be greatly reduced by close control of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels. In other words, these problems are not an inevitable outcome of having diabetes and can be prevented.[8]

It is important to stick to the treatment and lifestyle measures recommended by your doctor, to keep tight control of your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels, and to have regular check-ups so that your doctor can monitor your condition and alter your treatment if necessary.

Q. Will needle-free insulin become available soon?

A. Needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. delivery systems are already available in some countries - in fact they have been used since the 1940s.

These systems work by delivering insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. at a very high speed through the outer layer of the skin. Reports suggest, however, that many find them cumbersome. They are not pain-free and may cause some bleeding and bruising.[9, 10]

While needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. systems may be useful for people with a severe needle-phobia, their drawbacks prevent the routine use of these systems.

Drug manufacturers are always looking for new ways to deliver insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., so more needle-free technologies may become available in the future. A form of inhaled insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. was introduced in the UK in 2006, but was withdrawn from the market in 2008 for commercial reasons.

Q. Why did my doctor tell me to see my dentist because I have diabetes?

A. Problems with the teeth and gums can be more common for people with diabetes, who are more likely to develop tooth decay, gum disease and mouth ulcers, especially if bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. is not well-controlled. Also, dental infections can upset glucoseA simple sugar that is an important source of energy in the body. control.

Good dental care is especially important for people with diabetes. It is vital to maintain a good dental hygiene routine, with regular brushing and flossing, and to visit your dentist for regular dental check-ups.[11]

Q. I read that diabetes can affect your eyes. Should I be having regular eye tests?

A. Yes. People who have diabetes are at risk of a serious complicationA condition that is linked to, or is a consequence of, another disease or procedure. affecting the retina called diabetic retinopathy. This condition can lead to blindness if left untreated. People with diabetes also have an increased risk of cataracts and glaucomaIncreased pressure within the eye (intraocular pressure), which leads to visual loss..[12] Learn more about these complications.

Having regular eye checks enables these conditions to be detected and treated early enough to prevent loss of vision. Keeping close control of your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels also helps to reduce the risk of vision problems.

Q. I regularly play sport. I have just been diagnosed with diabetes - does this mean I have to stop or cut back on exercise?

A. No. People with diabetes can exercise just as anyone else can.[12]

In fact, exercise may be even more beneficial for people with diabetes than for people without the condition, since those with diabetes are more prone to conditions such as cardiovascular disease. Insulin resistanceThe ability of a microbe, such as a type of bacteria, to resist the effects of antibiotics or other drugs. is closely linked to being overweight or obese, and having an active lifestyle will help to combat this.

Your healthcare team can advise you about which sports and activities might be best for you and how to tailor your treatment to your exercise regime. If you start a new exercise or boost your training routine, it is important to increase exercise levels gradually.

Checking your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. before and after exercising will allow you to spot when your levels are too low or too high. For example, if your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. is very high before exercise, it may be best to avoid physical activity at that time because intense activity can cause levels to increase even further.

If you exercise for a long time, or skip a meal before exercising, your glucoseA simple sugar that is an important source of energy in the body. level may fall too low. It helps to have a sugary snack handy when doing any exercise.

Learn more about self-monitoring of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels.

Q. I have type 2 diabetes and I'm planning on running a half-marathon. Should I change my glucose intake or insulin units?

A. Speak with your healthcare team before adjusting your medication or dietary regime. Checking your glucoseA simple sugar that is an important source of energy in the body. levels before and after a shorter run will allow you to understand your body's response to exercise better, and this may help you to decide whether any changes are needed.

It is best to build up your exercise tolerance gradually, so that you know you can comfortably run that distance before the day of the half-marathon itself. Finally, remember that it is always helpful to keep a sugary snack with you on every run, including the half-marathon itself.[14]

Learn more about self-monitoring of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels.

Q. My friend is eight years old and has just been diagnosed with diabetes. Can he still come out to play?

A. Yes. There should be no reason why your friend cannot come out to play with you, or to prevent your friend from having a normal active life.

Q. My daughter's friend is coming for tea and she has diabetes - what can I give her to eat and what should I avoid?

A. The main dietary consideration for people with diabetes is to eat healthily.

If you are preparing food for someone with diabetes, make sure that portions are not over-sized, have salads and vegetables rather than chips, and provide food that is, for example, baked rather than fried.

Your daughter's friend may be on a specific dietary plan such as a low-salt diet. It may be best to ask her or her parents whether there are any specific considerations for you to take into account.

Q. How do I cope with my diabetes if I'm asked out for a meal?

A. Planning ahead can enable you to enjoy a meal out without breaking your dietary plan.

If you are eating with friends, it's fine to warn them that you are diabetic and that you may not be able to eat less healthy options such as dishes in cream sauce or deep-fried items. With advance warning, most people will be happy to provide a plain portion for you.

Many restaurants now cater for people who want to eat healthily, with menus that include salads, fish, vegetables and foods that are baked instead of fried. It's easy to ask the waiter discreetly if you need to know a dish's ingredients, or how large the portions are.

You can always request that no extra butter or salt is added to your meal; likewise, you can ask to substitute vegetables or salad for a portion of chips. Keeping an eye on your alcohol intake will help as well.[15]

Q. I've just been told I have diabetes and Ramadan is coming up: is it possible for me to manage my condition during a fast?

A. Yes, provided that your diabetes is well controlled and you plan ahead.

There are a number of factors to take into consideration if you have diabetes and are trying to decide whether or not to fast at Ramadan.[16,17] For example, how well is your diabetes controlled? Do you regularly suffer from episodes of low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar (hypoglycaemiaLow blood glucose levels.)?

It is best to avoid fasting if you are pregnant, or if you have other illnesses in addition to your diabetes - for example, anginaA central chest pain caused by insufficient oxygen supply to the heart. or a chest infectionInvasion by organisms that may be harmful, for example bacteria or parasites..

If you decide to go ahead with the fast, it is important to speak to your doctor or another member of your healthcare team to discuss any issues that may arise. They may advise changes to your medication dose or timing to allow for fasting.

One of the main risks to be aware of during fasting is that of developing low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-sugar levels (hypoglycaemiaLow blood glucose levels.). This risk may be greater if you are taking sulphonylurea medication or insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., and if Ramadan falls in the summer when the prescribed period of fasting from sunrise to sunset is longer than at other seasons.

Monitoring your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. at home will help. Remember, if you do have an episode of hypoglycaemiaLow blood glucose levels. you must break your fast.

Read more about self-monitoring of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels [link to feature]

Q. Both my husband and I are diabetic. We would love to start a family but I am concerned that our children will have the same problem. Is it hereditary?

A. The risk of developing diabetes can be passed on, but this is not inevitable, as both genetics and environmental factors are involved.

If a person has one or more close relatives with diabetes, his or her risk of developing diabetes is greater than normal. Not all of those with affected family members go on to develop diabetes, however - and steps can be taken to prevent the development of type 2 diabetes in particular.

Being aware from an early age of the greater risk of diabetes will help you and your husband to make informed choices about your child's diet and lifestyle.

Q. My father had type 2 diabetes that developed when he was 56. Does this mean that I'll get it, too, when I'm older?

A. Not necessarily.

It is true that the development of type 2 diabetes is influenced by your genes - in other words, having a close relative with this condition does increase your risk of developing it yourself. However there are steps that you can take to reduce this risk.

Diet and lifestyle are very important factors in the development of type 2 diabetes. Eating healthily, ensuring that you are not overweight or obese and taking regular exercise will all markedly reduce your risk. Being aware of these factors at an early age will allow you to make informed, healthy choices.

Q. Is there any treatment that allows people with diabetes to lead a normal life?

A. Both type 1 and type 2 diabetes can be treated effectively with healthy diet and lifestyle choices, together with oral medication and/or insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. injections where necessary.

Following a healthy diet and taking regular exercise are important for everyone's health, not just for people who have diabetes, although in diabetes these considerations are even more important.

Keeping your glucoseA simple sugar that is an important source of energy in the body. levels under close control will help to prevent the development of any complications from diabetes, such as heart disease.

Regular check-ups, for example regular eye tests, will help to pick up any problems early so that they can be treated effectively.

Q. I've just been diagnosed with type 2 diabetes. Will my treatment make me put on weight?

A. Weight gain can be an unwanted effect of some, but not all, types of anti-diabetic tablets. For example, a class of anti-diabetic drugs called sulphonylureas can encourage weight gain,[18] as can another class of drug called thiazolidinediones.

In order to avoid this, metformin, which does not promote weight gain, is considered the drug of choice for people with type 2 diabetes who are already very overweight.

Some people with type 2 diabetes will need insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. therapy if they cannot achieve satisfactory glucoseA simple sugar that is an important source of energy in the body. control with tablets alone. Studies have shown that patients with type 2 diabetes may gain weight after starting on insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. therapy.

This mainly seems to occur immediately after starting treatment and is thought to be due partly to 'defensive snacking', as patients may eat more because they are worried about becoming hypoglycaemic. In addition, insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. itself may promote a reduced metabolic rate and calorie retention, leading to weight gain if food intake is not adjusted to take this into account.

Newer types of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. may be less likely to cause weight gain. In some studies patients taking a combination of tablets and insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. did not put on more weight than those who were taking tablets alone.

It is important to discuss your concerns with your doctor and to report any weight gain that you experience as soon as it happens. It may be possible to alter your treatment.

The lifestyle changes that are recommended for patients with type 2 diabetes will also help to counteract any weight gain that may be experienced.

Q. Does having diabetes affect your appearance?

A. No. Having diabetes does not affect your appearance. No-one will be able to tell by looking at you that you have diabetes.

Q. I'm scared of needles - will I have to learn to inject myself?

A. There are two main types of diabetes, type 1 and type 2. People with type 1 diabetes need regular insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. to control their glucoseA simple sugar that is an important source of energy in the body. levels, and at present this usually has to be given by injections.

This is not the case for people with type 2 diabetes, who can usually take tablets to control their glucoseA simple sugar that is an important source of energy in the body. levels. However, many people with type 2 diabetes may need to take insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. eventually if their condition is not well-controlled.

Needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. delivery systems are available in some countries. They work by delivering insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. at a very high speed through the outer layer of the skin.

However, reports suggest that many people find these systems cumbersome. Moreover, they are not pain-free and may cause some bleeding and bruising. So while needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. systems may be useful for people with severe needle phobia, these drawbacks prevent their routine use.

Practical guide to coping with needles in diabetes.

Q. Is self-monitoring important? If my blood glucose is too low or too high, what can I do about it?

A. Yes, self-monitoring is important and can make a great contribution to managing your diabetes and avoiding complications.

Self-monitoring can help you to control your glucoseA simple sugar that is an important source of energy in the body. levels by guiding day-to-day choices in diet and exercise and, in the longer-term, adjustment of medication.

Keeping a diary of the results of self-monitoring may help when speaking with your healthcare team. Your doctor or nurse will advise you on how you can correct levels that are too low or too high by adjusting your intake of carbohydratesA group of compounds that are an important energy source, including sugars and starch., exercising or changing your insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. dose if your diabetes is insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.-controlled.[19]

Find out more about self-monitoring of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels.

Q. I am 16 and feel very self-conscious about injecting myself before lunch at school. Some of my mates are calling me a junkie. Is there any other way of managing my sugar levels when I am with a crowd of people?

A. Try speaking to your teachers. They should be able to provide you with a place where you can take your insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. in private rather than in front of your friends, if you feel more comfortable with this.

However, it is important to remember that your injections are important to your health. If you are in a situation where you need an injection and you do not have a separate place to go to, this should not prevent you from taking your medication.

Your friends are behaving in this way because they do not understand what diabetes is or how it is treated. It is important to make sure that you do not let them stop you from having the best care available.

Read more about coping with needles in diabetes [link to feature]

Q. I'm going on holiday with my friend who has diabetes. How will I know if she has a hypo and what do I do about it?

A. The symptoms of hypoglycaemiaLow blood glucose levels. usually develop quite quickly. They may include sweating and feeling shaky, weak, nauseous, irritable or confused, or drowsy.[20,21]

Your friend will probably know how to recognise these symptoms, although they may not be so clear in some people. If you recognise these symptoms early you can encourage your friend to eat or drink something sweet, such as a fizzy drink containing sugar (not a no-sugar or diet version), followed by something more substantial like toast or a sandwich.

If a person's bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar falls very low, he or she may have a reduced consciousness level so that eating or drinking will not be possible. If your friend becomes too drowsy, confused or incoherent to respond normally, it is important to call a doctor urgently.

If you are travelling abroad it will help to know how to contact the emergency services in the country you are visiting.

Q. If I go on holiday, will I be able to take the needles for my insulin onto the aeroplane?

A. Yes, but it is important to make sure that you have a letter from your doctor explaining that you need to keep your insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. with you. If in doubt, it may be best to inform the airline beforehand so that they are aware of your situation.

References: 
  1. 'Type 2 diabetes: Treatments and drugs.' MayoClinic.com. http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=treatm...
  2. Pre-diabetes: a position statement from the Australian Diabetes Society and Australian Diabetes Educators Association. Twigg SM, Kamp MC, Davis TM et al. MJA. 2007;186(9):461-5.
  3. 'The IDF consensus worldwide definition of the metabolic syndromeThe combination of insulin resistance, abdominal obesity, high blood pressure and disordered blood lipids that increases the risk of cardiovascular disease..' International Diabetes Federation. http://www.idf.org/webdata/docs/MetSyndrome_FINAL.pdf accessed on 21 May, 2009.
  4. The metabolic syndromeThe combination of insulin resistance, abdominal obesity, high blood pressure and disordered blood lipids that increases the risk of cardiovascular disease. - a new worldwide definition. Alberti KGMM, Zimmet P and Shaw J. The Lancet. 2005;366:1059-62.
  5. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Buchwald H, Estok R, Fahrbach K et al. The American Journal of Medicine, Vol122, Issue 3, Pages 248-256.e5 (March 2009). http://www.ncbi.nlm.nih.gov/pubmed/19272486.
  6. Transplantation for the treatment of type 1 diabetes. Meloche RM. World J Gastroenterol. 2007;13(47):6347-55.
  7. Association of glycaemia with macrovascularRelating to large blood vessels. and microvascularRelating to small blood vessels. complications of type 2 diabetes (UKPDS 35): prospective observational study. Stratton IM, Adler AI, Neil HAW et al. BMJ 2000;321:405-12.
  8. Association of glycaemia with macrovascularRelating to large blood vessels. and microvascularRelating to small blood vessels. complications of type 2 diabetes (UKPDS 35): prospective observational study. Stratton IM, Adler AI, Neil HAW et al. BMJ 2000;321:405-12.
  9. Needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. Brown H. Br J Diabetes Vasc Dis. 2004;4:113-5.
  10. 'Worcestershire guidelines for use of needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. delivery systems.' Worcestershire Acute Hospitals Trust (WHAT). www.worcspct.nhs.uk/file_download.aspx?nav=primarycare&id=3e5f200a-b942-... accessed on 21 May 2009.
  11. 'Diabetes and dentistry.' Diabetes.co.uk. http://www.diabetes.co.uk/Diabetes-and-dentistry.html
  12. ABC of diabetes: Retinopathy. Watkins PJ. BMJ. 2003;326;924-926.
  13. 'Don't let diabetes get in your way.' American Diabetes Association. http://www.diabetes.org/food-nutrition-lifestyle/fitness/getting-motivat... accessed 2 June 2009.
  14. Insulin-dependent diabetes mellitusDisordered energy metabolism and high levels of glucose in the blood owing to a lack of insulin, or poor response of the body to insulin. and marathon running. Jensen TH, Darre E, Holmich P et al. Br J Sports Med. 1987;21:51-2.
  15. 'Your guide to eating out.' American Diabetes Association. http://www.diabetes.org/nutrition-and-recipes/nutrition/eatingoutguide.jsp accessed 2 June 2009.
  16. 'Choosing to fast this Ramadan?' Leicestershirediabetes.org.uk. http://www.leicestershirediabetes.org.uk/display/templatedisplay1.asp?se... accessed 2 June 2009.
  17. http://www.croydon.nhs.uk/reports/pdfs/ramadanleafletkw.pdf
  18. Sulfonylurea Inadequacy: Efficacy of addition of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57). Wright A, Burden ACF, Paisley PB et al. Diabetes Care 2002;25:330-6.
  19. Self-monitoring of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body.: The basics. Benjamin EM. Clinical Diabetes. 2002;20(1):45-7.
  20. M Longmore, I Wilkinson and E Török. Oxford handbook of clinical medicine. OUP Oxford 2002 ; 5th edition.
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