Diabetes is a group of diseases that occur when the pancreas is not producing enough of the hormone insulin, or if the body becomes unresponsive to the effects of insulin. The high blood sugar levels that result from this can manifest in a host of different symptoms, many of which can lead to further health complications. We manage patients with diabetes as part of our acute physician work at King’s College Hospital.  

We offer diagnostic and therapeutic advice for Type 1 and Type 2 diabetes, and diabetes that is secondary to other conditions – for example, pancreatic disease or surgery – in The Guthrie Wing, at our private clinics at 25 Harley Street and The Shard, or on the ward. Diabetes can also be secondary to pituitary or adrenal diseases such as Cushing’s syndrome or acromegaly, or be associated with an iron overload in haemochromatosis. These possibilities should always be considered otherwise patients will not get the correct treatment. Rarely, diabetes can be due to genetic conditions – which require very specific treatment.

The management of diabetes is an area of exciting change, with new agents becoming available. We can ensure that the most appropriate treatments are considered. 

Lifestyle changes remain important, though, and in medical therapy metformin remains the primary treatment. For patients with a high risk of cardiovascular disease, SGLT-1 inhibitors are helpful if added to metformin. Often DPP-IV inhibitors will be needed, and these are now an established class. For some patients, pioglitazone still has a clear role, especially if liver dysfunction is present. Where weight is troublesome and insulin proves difficult to use, we now have experience with GLP-1 analogues, including established drugs like exenatide (Byetta, Rydurion), dulaglutide (Trulicity) and newer drugs such as semaglutide (orally as Rybelsus, or as an injection in Ozempic, and also found in Wegovy for obesity).

If you have pre-diabetes or a family history of diabetes, we can consider how to reduce your chance of becoming diabetic. This may include the specific management of obesity in close liaison with dietetics, medications such as orlistat and GLP-1 agonists, and/or surgery.

If you are interested in finding out how newer therapies such as SGLT-2 inhibitors can help, for instance if you have heart failure, and whether or not you have diabetes, then please contact us.  

Hypoglycaemia – where your blood sugar levels fall below the normal range – needs prompt investigation, whether it occurs on fasting, after meals or unpredictably. Whether you are certain you have hypoglycaemia or are concerned that it might be responsible for your symptoms, we can assess the majority of patients quickly and safely as an outpatient.

If you have hypoglycaemia in the context of Type 1 diabetes and/or insulin therapy please email us first so we can have you seen by the right person straight away.

Being overweight is often a critical modifiable risk for diabetes, and by focusing on your weight, you can help to avoid, manage or even put into remission your diabetes. Some treatments can make managing your weight even more difficult, and in every case we can work together to find the right balance between health benefits and side effects.

Diabetes, and in particular Type 2 diabetes, can cause sexual dysfunction – for example, erectile dysfunction, which can in turn be a sign of cardiovascular disease or endocrine dysfunction. By improving your general health, and if necessary assessing your pituitary, androgens, thyroid or adrenal hormonal status, we can help. Frustratingly, men are rarely asked about this aspect of their health in their routine care, even though excellent treatments are now available for erectile dysfunction. If they are appropriate to you we can prescribe these treatments, but we also work very closely with colleagues in urology across London for the very specific management of erectile dysfunction if standard treatments do not work. Similarly, we may also consider whether a more detailed look at your cardiovascular or endocrine health is needed.

The high blood sugar levels associated with long-standing diabetes can damage the fine nerves in the feet, legs and – more rarely – the fingers and hands, causing numbness and pain. We can design a plan of care to prevent this or, if it is already present, help to make an accurate diagnosis, followed by treatment to make the condition more comfortable.

Long-standing diabetes can damage the kidneys, particularly if the patient is also suffering from hypertension or high blood pressure. In some patients, the kidney damage can progress, in some cases leading to kidney failure. We always work with you to help manage your diabetes to prevent and/or delay any kidney damage. This can include an accurate diagnosis in the very early stages, where tiny quantities of albumin leak out into the urine. Sometimes this work is done alongside a kidney specialist, depending on what treatment works best for you.

Diabetes often requires a patient to take several medicines – for good glucose control, to treat blood pressure and lipids, to minimise kidney and/or nerve damage, and to reduce the risk of cardiovascular disease. Many of the medicines have side effects, and sometimes they may not work well with each other, your diet or your lifestyle. Patients taking GLP-1 agonists, for example, often experience nausea which can get better over time, or constipation or diarrhoea which may persist.

In every case, we make sure the medication is exactly right for you, both in the short-term and in your longer-term treatment.

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