High cholesterol
of blood and lymph

Cholesterol is a fatty substance known as a lipid. It’s vital for the normal functioning of the body. Cell membranes, hormones and vitamin D are created by your body using cholesterol.

There are 2 main sources of the cholesterol in your blood:

cholesterol in the food you eat cholesterol produced by your liver

Having an excessively high level of lipids in your blood (hyperlipidemia) can have an effect on your health.

High cholesterol, on its own, doesn’t usually cause any symptoms but increases your risk of serious health conditions.


Cholesterol is carried in your blood by proteins. When the two combine, they’re called lipoproteins. There are two main types of lipoprotein.

High-density lipoprotein (HDL) carries cholesterol away from the cells and back to the liver. From there it’s either broken down or passed out of the body as a waste product. For this reason, HDL is referred to as “good cholesterol” and higher levels are better.

Low-density lipoprotein (LDL) carries cholesterol to the cells that need it. If there’s too much cholesterol for the cells to use it can build up in the artery walls, leading to disease of the arteries. For this reason, LDL is known as “bad cholesterol”.

The amount of cholesterol in the blood, both HDL and LDL , is measured with a blood test.

The recommended cholesterol levels in the blood vary between those with a higher or lower risk of developing arterial disease.

Causes

Evidence strongly indicates that high cholesterol can increase the risk of:

narrowing of the arteries (atherosclerosis) heart attack stroke transient ischaemic attack (TIA) – often known as a “mini stroke” peripheral arterial disease (PAD)

This is because cholesterol can build up in the artery wall, restricting the blood flow to your heart, brain and the rest of your body. It also increases the risk of a blood clot developing somewhere in your body.

Your risk of developing coronary heart disease also rises as your blood’s cholesterol level increases. This can cause pain in your chest or arm during stress or physical activity (angina).


Many factors can increase your chances of having heart problems or a stroke if you have high cholesterol.

These include:

an unhealthy diet – in particular, eating high levels of saturated fat smoking – a chemical called acrolin, found in cigarettes, stops HDL transporting cholesterol from fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis) having diabetes or high blood pressure (hypertension) having a family history of stroke or heart disease

There’s also an inherited condition called familial hypercholesterolaemia. This can cause high cholesterol even in someone who eats healthily.

Read more about the causes of high cholesterol


Many different factors can contribute to high blood cholesterol, including lifestyle factors like smoking, an unhealthy diet and lack of exercise, as well as having an underlying condition, such as high blood pressure or diabetes.

Diagnoses

Your GP may recommend that you have your blood cholesterol levels tested if you:

have been diagnosed with coronary heart disease, stroke or mini stroke (TIA), or peripheral arterial disease (PAD) have a family history of early cardiovascular disease have a close family member who has a cholesterol-related condition are overweight have high blood pressure, diabetes or a health condition that can increase cholesterol levels

Read more about how cholesterol is tested


Blood cholesterol levels are measured with a simple blood test.


A blood sample is taken that will be used to determine the amount of bad cholesterol (low-density lipoprotein, or LDL), good cholesterol (high-density lipoprotein, or HDL) and other fatty substances (triglycerides) in your blood.

You may be asked not to eat for 10-12 hours before the cholesterol test, usually including when you’re asleep at night. This ensures that all food is completely digested and won’t affect the outcome of the test.

Your GP or practice nurse can carry out the cholesterol test and will take a blood sample, either using a needle and a syringe or by pricking your finger.

A newer type of test that measures non-high-density lipoprotein (non-HDL) is now sometimes used because it’s thought to be a more accurate way of estimating cardiovascular disease (CVD) risk than LDL.

Non-HDL cholesterol is total cholesterol minus HDL cholesterol. It’s also not necessary to fast before the test, so it is more convenient.


Your GP may recommend that you have your blood cholesterol levels tested if you:

have been diagnosed with coronary heart disease, stroke or mini-stroke (TIA), or peripheral arterial disease (PAD) are over the age of 40 – people over 40 should have their estimate of CVD risk reviewed regularly have a family history of early cardiovascular disease – for example, if your father or brother developed heart disease or had a heart attack or stroke before the age of 55, or if your mother or sister had these conditions before the age of 65 have a close family member who has a cholesterol-related condition, such as familial hypercholesterolaemia are overweight or obese have high blood pressure or diabetes have another medical condition, such as kidney disease, an underactive thyroid, or an inflamed pancreas (pancreatitis) – these conditions can cause increased levels of cholesterol or triglycerides

Treatments

Your GP may recommend that you have your blood cholesterol levels tested if you:

have been diagnosed with coronary heart disease, stroke or mini stroke (TIA), or peripheral arterial disease (PAD) have a family history of early cardiovascular disease have a close family member who has a cholesterol-related condition are overweight have high blood pressure, diabetes or a health condition that can increase cholesterol levels

Read more about how cholesterol is tested


If you’ve been diagnosed with high cholesterol, you’ll be advised to make changes to your diet and increase your level of exercise.

After a few months, if your cholesterol level hasn’t dropped, you may be advised to take cholesterol-lowering medication.

Changing your diet, stopping smoking and exercising more will also help to prevent high cholesterol developing.

The various treatments for high cholesterol are outlined below. 

Preventions

You can lower your cholesterol by eating a healthy, balanced diet that’s low in saturated fat, exercising regularly, not smoking and cutting down on alcohol.

HIV
of immune system

HIV is a long term health condition which is now very easy to manage. HIV stands for human immunodeficiency virus. The virus targets the immune system and if untreated, weakens your ability to fight infections and disease.

Nowadays, HIV treatment can stop the virus spreading and if used early enough, can reverse damage to the immune system.

HIV is most commonly transmitted through having unprotected sex with someone with HIV who isn’t taking HIV treatment. Unprotected sex means having sex without taking HIV PrEP or using condoms.

HIV can also be transmitted by:

sharing infected needles and other injecting equipment an HIV-positive mother to her child during pregnancy, birth and breastfeeding

All pregnant women are offered an HIV test and if the virus is found, they can be offered treatment which virtually eliminates risk to their child during pregnancy and birth.

People who take HIV treatment and whose virus level is undetectable can’t pass HIV on to others. Although there is no cure for HIV yet, people living with HIV who take their treatment should have normal lifespans and live in good health.

Without treatment, people with HIV will eventually become unwell. HIV can be fatal if it’s not detected and treated in time to allow the immune system to repair. It’s extremely important to test for HIV if you think you’ve been exposed.

Symptoms

People who are infected with HIV, often experience a short flu like illness that occurs 2 to 6 weeks after infection. This is known as primary HIV infection.

The most common symptoms are:

fever (raised temperature) sore throat body rash

Other symptoms can include:

tiredness joint pain muscle pain swollen glands (nodes)

However, these symptoms are most commonly caused by conditions other than HIV, and do not mean you have the virus.

If you have several of these symptoms, and you think you have been at risk of HIV infection within the past few weeks, you should get an HIV test.

After the initial symptoms disappear, HIV may often not cause any further symptoms for many years. During this time, HIV continues to be active and causes progressive damage to your immune system.

Once the immune system becomes severely damaged symptoms can include:

weight loss chronic diarrhoea night sweats skin problems recurrent infections serious life-threatening illnesses

Earlier diagnosis and treatment of HIV can prevent these problems occurring and reverse them.

Read more about treating HIV

It is recommended you should still take an HIV test if you have put yourself at risk at any time in the past, even if you experience no symptoms.

Want to know more?

Terrence Higgins Trust: Stages of HIV infection nam aidsmap: HIV and AIDS

Causes

Diagnoses

The only way to find out if you have HIV is to have an HIV test, as symptoms of HIV may not appear for many years.

HIV testing is provided to anyone free of charge on the NHS. Many clinics can give you the result on the same next day and home-testing and home-sampling kits are also available. Home-testing and home sampling kits are also available from some services and charities or to buy online.


Anyone who thinks they could have HIV should get tested.

Certain groups of people are at particularly high risk and are advised to have regular tests. For example:

gay and bisexual men or men who have sex with men are advised to have an HIV test at least once a year, or every 3 months, if having sex without HIV PrEP or condoms with new or casual partners women and men from countries with high HIV prevalence, especially from sub Saharan Africa are advised to have an HIV test, if having sex without using HIV PrEP or condoms with new or casual partners people who inject drugs or who have sex without using HIV PrEP and condoms with people who inject drugs

Read more about how you get HIV


Seek health care advice immediately if you think there’s a chance you could have HIV. The earlier it’s diagnosed, the earlier you can start treatment and avoid becoming ill.

Some HIV tests may need to be repeated four weeks after exposure to HIV infection, but you shouldn’t wait this long to seek help.


There are various places you can go to for an HIV test, including:

sexual health clinics clinics run by charities such as the Terrence Higgins Trust or Waverly Care Scotland some GP surgeries local drug dependency services a private clinic, where you will have to pay

An HIV test is one of the range of tests routinely offered to all women in Scotland as part of antenatal screening. There are also home-sampling and home-testing kits (see below) you can use if you don’t want to visit any of these places.


There are 4 main types of HIV test:

full blood test – where a sample of blood is taken in a clinic and sent for testing in a laboratory. Results are usually available within a few days. “point of care” test – where a sample of saliva from your mouth or a small spot of blood from your finger is taken in a clinic. This sample doesn’t need to be sent to a laboratory and the result is available within a few minutes. home-sampling kit – where you collect a saliva sample or small spot of blood at home and send it off in the post for testing. You’ll be contacted by phone or text with your result in a few days. You can buy them online or from some pharmacies. home-testing kit – where you collect a saliva sample or small spot of blood yourself and test it at home. The result is available within minutes. It’s important to check that any test you buy has a CE quality assurance mark and is licensed for sale in the UK, as poor quality HIV self-tests are available from overseas.

If the test finds no sign of infection, your result is “negative”. If signs of infection are found, the result is “positive”.

The full blood test is the most accurate test and can normally give reliable results from four weeks after infection. The other tests whilst also accurate, may not give a reliable result for a longer period after exposure to the infection (this is known as the “window period”).

For all these tests, a full blood test should be carried out to confirm the result if the first test is positive. If this test is also positive, you’ll be referred to a specialist HIV clinic for some more tests and a discussion about your treatment options.

Online appointment bookingYou may be able to book an appointment for an HIV test online using the online booking system. This varies for different NHS board areas.Sexual health services online appointments booking system

Treatments

Treatments for HIV are now very effective, enabling people with HIV to live long and healthy lives.

Medication, known as antiretrovirals, work by stopping the virus replicating in the body, allowing the immune system to repair itself and preventing further damage. These medicines usually come in the form of tablets, which need to be taken every day.

HIV is able to develop resistance to a single HIV drug very easily, but taking a combination of different drugs makes this much less likely. Most people with HIV take a combination of 3 antiretrovirals (although some people take 1 or 2) and it’s vital that the medications are taken every day as recommended by your doctor.

Taking a number of different drugs doesn’t always mean taking many tablets though as some drugs are combined together into one tablet.

For people living with HIV, taking effective antiretroviral therapy (where the HIV virus is “undetectable” in blood tests) will prevent you passing on HIV to sexual partners.

It’s extremely rare for a pregnant woman living with HIV to transmit it to their babies, provided they receive timely and effective antiretroviral therapy (ART) and medical care. An HIV test is routinely offered to all women in Scotland as part of antenatal screening.

Read more about living with HIV


Seek health care advice immediately if you think there’s a chance you could have HIV. The earlier it’s diagnosed, the earlier you can start treatment and avoid becoming ill.

Some HIV tests may need to be repeated four weeks after exposure to HIV infection, but you shouldn’t wait this long to seek help.


Although HIV cannot be cured, it’s a very manageable long term condition and effective treatment is available to enable individuals to live a long and healthy life.

If you’re diagnosed with HIV, you’ll be referred to a specialist HIV clinic for treatment, regular monitoring and care.

It’s recommended that everyone diagnosed with HIV starts treatment shortly after being diagnosed to keep in good health and free of symptoms. Treatment for HIV is generally very well tolerated.Medication, known as antiretrovirals, work by stopping the virus replicating in the body, allowing the immune system to repair itself and preventing further damage. These medicines come in the form of tablets which need to be taken every day.HIV can develop resistance to a single HIV drug very easily, but by taking a combination of different drugs or with support from your doctor in taking your treatment, resistance is less likely. Most people with HIV take a combination of three antiretrovirals (although some people take 1 or 2) and it’s vital that the medications are taken every day as recommended by your doctor.For people living with HIV, taking effective antiretroviral therapy (where the HIV virus is “undetectable” in blood tests) will prevent you passing on HIV to sexual partners.

Read more about treating HIV:

Terrence Higgins Trust: Treatment for HIV HIV i-Base: Introduction to combination therapy


HIV treatment is generally very well tolerated. Your HIV clinic will monitor your health for side effects.

Common side effects include:

nausea diarrhoea skin rashes sleep difficulties

People with HIV get treatment at a specialist HIV clinic which is usually part of a sexual health or infectious diseases clinic at your local hospital.

Services, including support organisations, may work together to provide specialist care and emotional support.

Find out more about living with HIV

Preventions

It has never been easier to prevent the transmission of HIV.

Someone living with HIV who takes their HIV treatment and who has had an undetectable level of virus for six months, cannot transmit HIV to anyone else. Over 90% of all people diagnosed with HIV in Scotland have undetectable virus. It’s therefore extremely rare for someone to get HIV from a person that knows they have the virus.

HIV Pre Exposure Prophylaxis (PrEP)

PrEP is a form of HIV medication taken by someone who does not have HIV which will help to prevent them from getting HIV. In Scotland PrEP is available on the NHS through sexual health clinics for people who are at risk of getting HIV. PrEP only provides protection from HIV and not from any other sexually transmitted infections.

Read further information about HIV PrEP

Condoms (and lubricant)

Properly used condoms (and lubricant for anal sex) are effective at preventing transmission of HIV as well as other sexually transmitted infections and pregnancy.

HIV Post Exposure Prophylaxis (PEP)

HIV Post exposure prophylaxis (PEP) is a form of emergency HIV medication taken by someone who does not have HIV but who has or may have been very recently exposed to HIV.

PEP should be taken as soon as possible, but it can be taken up to 72 hours after exposure. The earlier it is taken the more effective it is.

Clean Injecting Equipment

Using fresh injecting equipment, including any needles, syringes, swabs and spoons and avoiding sharing will eliminate any risk of HIV.


The best ways to prevent HIV are to take PrEP before exposure to HIV, use a condom for sex and to never share needles or other injecting equipment (including syringes, spoons and swabs).

Taking PrEP before you’re exposed to HIV means that there’s a drug inside of you to block HIV if it gets into your body, so it can’t infect you.

If you have HIV, it’s important to take your HIV medication. If HIV medication makes your viral load undetectable, you won’t pass the virus on to anyone else.

HIV Pre Exposure Prophylaxis (PrEP)

If you think you may come into contact with HIV, taking anti-HIV medication beforehand will stop you becoming infected.

Read further information about HIV PrEP

HIV Post Exposure Prophylaxis (PEP)

If you think you may have been exposed to HIV and you haven’t taken PrEP medication or used a condom, you should take PEP medication.

Post exposure prophylaxis (PEP) is a form of emergency HIV medication taken by someone who does not have HIV but who has or may have been very recently exposed to HIV.

PEP should be taken as soon as possible, but it can be taken up to 72 hours after exposure. The earlier it is taken the more effective it is.

PEP is available from sexual health services or out of hours from A&E.

Condoms

Condoms come in a variety of shapes, colours, textures, materials and flavours. Both male and female condoms are available.

A condom is the most effective form of protection against HIV and other STIs. It can be used for vaginal and anal sex, and for oral sex performed on men.

HIV can be passed on before ejaculation, through pre-cum and vaginal secretions, and from the anus.

It is very important that condoms are put on before any sexual contact occurs between the penis, vagina, mouth or anus.

You can get free condoms in most areas of Scotland, check your local sexual health service website for details.

Lubricant

Lubricant, or lube, is often used to enhance sexual pleasure and safety, by adding moisture to either the vagina or anus during sex.

Lubricant can make sex safer by reducing the risk of anal or vaginal tears caused by dryness or friction, and it can also prevent a condom from tearing. Lubricant for vaginal sex is only recommended for women that have low vaginal moisture.

Only water-based lubricant (such as K-Y Jelly) rather than an oil-based lubricant (such as Vaseline or massage and baby oil) should be used with condoms.

Oil-based lubricants weaken the latex in condoms and can cause them to break or tear.

Find out more about what sexual activities can put you at risk of HIV and other STIs on the Sexual Health Scotland website.

Sharing needles and injecting equipment

If you inject drugs, you shouldn’t share needles, syringes or other injecting equipment such as spoons and swabs as this could expose you to HIV and other viruses found in the blood, such as hepatitis C.

Many local authorities and pharmacies offer needle exchange programmes, where used needles can be exchanged for clean ones.

A GP or drug counsellor should be able to advise you about free injecting equipment provision including needles.

If you are having a tattoo or piercing, it’s important that a clean, sterilised needle is always used.

Hodgkin lymphoma
of cancer, cancer types in adults

Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes.

In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.

The most common symptom of Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.

Read more about the symptoms of Hodgkin lymphoma.

Symptoms

The most common symptom of Hodgkin lymphoma is a swelling in the neck, armpit or groin. The swelling is usually painless, although some people find that it aches.

The swelling is caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph node (also called lymph glands). Lymph nodes are pea-sized lumps of tissue found throughout the body. They contain white blood cells that help to fight infection.

However, it’s highly unlikely that you have Hodgkin lymphoma if you have swollen lymph nodes, as these glands often swell as a response to infection.


Some people with Hodgkin lymphoma also have other more general symptoms. These can include:

night sweats unintentional weight loss a high temperature (fever) a persistent cough or feeling of breathlessness persistent itching of the skin all over the body

Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion

A few people with lymphoma have abnormal cells in their bone marrow when they’re diagnosed. This may lead to:

persistent tiredness or fatigue an increased risk of infections excessive bleeding – such as nosebleeds, heavy periods and spots of blood under the skin

In some cases, people with Hodgkin lymphoma experience pain in their lymph glands when they drink alcohol.

Causes

The exact cause of Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if:

you have a medical condition that weakens your immune system you take immunosuppressant medication you’ve previously been exposed to a common virus called the Epstein-Barr virus – which causes glandular fever

You also have an increased risk of developing Hodgkin lymphoma if a first-degree relative (parent, sibling or child) has had the condition.

Read more about the causes of Hodgkin lymphoma.


Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called B lymphocytes, although the exact reason why this happens isn’t known.

The DNA gives the cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions so the cells keep growing, causing them to multiply uncontrollably.

The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, it’s possible for the abnormal lymphocytes to spread into other parts of your body, such as your:

bone marrow spleen liver skin lungs

Diagnoses

The only way to confirm a diagnosis of Hodgkin lymphoma is by carrying out a biopsy.

This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory.

Read more about diagnosing Hodgkin lymphoma.


If you speak to your GP because you’re concerned about symptoms of Hodgkin lymphoma, they’ll ask about your health and carry out a simple physical examination.

If necessary, your GP will refer you to hospital for further tests.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of Hodgkin lymphoma and refer people for the right tests faster.

To find out if you should be referred for further tests for suspected Hodgkin lymphoma, read the NICE 2015 guidelines on Suspected cancer: recognition and referral.

If you’re referred to hospital, a biopsy will usually be carried out, as this is the only way to confirm a diagnosis of Hodgkin lymphoma.


If a biopsy confirms a diagnosis of Hodgkin lymphoma, further testing will be needed to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma.

Further tests may include:

blood tests – samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidneys are working bone marrow sample – another biopsy may be carried out to see if the cancer has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic chest X-ray – this can check whether the cancer has spread to your chest or lungs computerised tomography (CT) scan – this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread of the cancer magnetic resonance imaging (MRI) scan – this scan uses strong magnetic fields to build up a detailed picture of areas of your body, to check the spread of the cancer positron emission tomography (PET) scan – this scan measures the activity of cells in different parts of the body and can check the spread of the cancer and the impact of treatment; it’s usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working

Treatments

Hodgkin lymphoma is a relatively aggressive cancer and can quickly spread through the body. Despite this, it’s also one of the most easily treated types of cancer.

Your recommended treatment plan will depend on your general health and age, because many of the treatments can put a tremendous strain on the body. How far the cancer has spread is also an important factor in determining the best treatment.

The main treatments used are chemotherapy, followed by radiotherapy or chemotherapy alone. Surgery isn’t generally used as a treatment for the condition.

Read more about:

treatment for Hodgkin lymphoma complications of Hodgkin lymphoma


Speak to your GP if you have any of these symptoms, particularly if you have persistently swollen glands with no other signs of infection.

While the symptoms are unlikely to be caused by Hodgkin lymphoma, it is best to get them checked out.


Hodgkin lymphoma can usually be treated successfully with chemotherapy alone, or chemotherapy followed by radiotherapy.


Your specific treatment plan will depend on your general health and your age, as many of the treatments can put a tremendous strain on the body. How far the cancer has spread is also an important factor in determining the best treatment.

Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT).

Your MDT will recommend the best treatment options for you. However, you shouldn’t be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.


The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. In a few cases, chemotherapy may be combined with steroid medication.

Surgery isn’t generally used to treat the condition, except for the biopsy used to diagnose it.

Overall, treatment for Hodgkin lymphoma is highly effective and most people with the condition are eventually cured.

Complications

Some people treated for Hodgkin lymphoma experience long-term problems, even if they’ve been cured.

Hodgkin lymphoma: Children
of cancer, cancer types in children

More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past.

It’s devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your child’s specialist will give you more detailed information and, if you have any questions, it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.


It’s devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your child’s specialist will give you more detailed information and, if you have any questions, it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.


Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your child’s specialist will give you more detailed information and, if you have any questions, it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Symptoms

The first sign of Hodgkin lymphoma is usually a painless swelling of 1 gland, or a group of lymph glands, which continues for some weeks or even months. The first glands that are likely to be affected are in the neck or above the collarbone, most often only on 1 side. However, it’s important to remember that children’s glands can also become swollen when they have a common infection that causes a sore throat or a cold. If glands in the chest are affected, this can cause a cough or breathlessness. This is caused by the pressure the glands exert on the airways.

Sometimes, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, weight loss or itchy skin.

Causes

The exact cause of Hodgkin lymphoma is not known. In most people that develop Hodgkin lymphoma, no cause is found. However, there is increasing evidence that infections, such as the virus that causes glandular fever, may play a part in the development of Hodgkin lymphoma, especially in childhood. Poor immunity may also be a risk factor for developing the disease. Very rarely, more than one member of a family may develop Hodgkin lymphoma but it is not inherited from parents and you cannot catch it from another person.

Diagnoses

As lymph glands can swell for lots of reasons, a biopsy is carried out to diagnose Hodgkin lymphoma. A biopsy is when a swollen lymph gland is removed and the cells are looked at under a microscope. It’s a small operation which is usually done under a general anaesthetic. Sometimes only a small part of the lymph gland has to be removed, which can be done under a local anaesthetic.

If Hodgkin lymphoma is diagnosed after the biopsy, further tests are carried out to find out the exact size and position of the lymphoma, and to see whether it has spread beyond the original area. These tests include X-rays, blood tests, CT, MRI and PET scans.

Very often, a bone marrow sample will be taken. This is because the lymphoma cells can spread to the bone marrow as well as to other lymph glands.

The tests that are carried out are called staging tests. Any tests and investigations that your child needs will be explained to you. The Children’s Cancer and Leukaemia Group (CCLG) has more information about what the tests and scans involve.

Staging

The stage of Hodgkin lymphoma describes the size and position of the cancer and whether it has spread. Staging is very important because the type of treatment your child receives will depend on the stage of the disease. The staging system for Hodgkin lymphoma is as follows:

stage 1 – only 1 group of lymph nodes is affected and the lymphoma is only on 1 side of the diaphragm (the sheet of muscle under the lungs that controls breathing) stage 2 – 2 or more groups of lymph nodes are affected, but they are only on 1 side of the diaphragm. stage 3 – the lymphoma is in lymph nodes both above and below the diaphragm stage 4 – the lymphoma has spread outside the lymph nodes to other organs such as the liver, lungs or bone marrow

As well as giving each stage a number, doctors also use a letter code – either A, B, or E:

A means your child has no symptoms B means your child has 1 or more of the following symptoms: a fever, night sweats or significant weight loss E means that the lymphoma has grown from the lymph gland to extranodal tissue (tissue in places outside the lymph nodes)

A number and letter is used in the staging of every child with Hodgkin lymphoma. This helps the doctor decide on a treatment plan for your child.

Treatments

Children with Hodgkin lymphoma are usually treated with chemotherapy, but sometimes radiotherapy is also needed. The type and amount of treatment given depend on the stage of the disease when it is diagnosed. Your child’s doctor will discuss the treatment options with you.

Chemotherapy

This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

It is usual for a combination of drugs to be used, which will often be given every few weeks over a number of months. A combination of drugs is used because each chemotherapy drug works in a different way. Using several drugs together increases the effectiveness of the treatment. It also means lower doses of individual drugs can be used, which may reduce the possibility of long-term side effects.

Radiotherapy

This is used in less than half of people with Hodgkin lymphoma. It treats cancer by using high energy rays that destroy the cancer cells while doing as little harm as possible to normal cells.

Side effects of treatment

Treatment for Hodgkin lymphoma can cause side effects, and your child’s doctor will discuss these with you before the treatment starts. Any possible side effects will depend on the particular treatment being used and the part of the body that is being treated.

Some general side effects of chemotherapy that can occur during treatment include:

feeling sick (nausea) and being sick (vomiting) hair loss low blood count which can lead to an increased risk of infection, bruising and bleeding tiredness

Changes to your child’s sense of taste and changes in their bowel may also happen. If your child has side effects from the treatment it is important to discuss them with your doctor or nurse. They may be able to help reduce them.

Late side effects of treatment

The cure rate for Hodgkin lymphoma is very high, which means some children may develop side effects many years after treatment. The chance of developing late side effects depends on where the original tumour was, how far it spread, and the type of treatment your child had.

These late side effects can affect the normal organs such as the heart, kidneys and lungs. Following treatment for Hodgkin lymphoma, there is a small increase in the risk of developing another cancer in later life. There is also a chance that fertility may be affected. Teenage boys who are diagnosed after puberty should have the option of sperm banking before treatment starts. In this situation, sperm can be stored for possible use in later years.

Your child’s doctor or nurse will explain more about any possible late side effects.

Clinical trials

Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version.

The aim of treatment for Hodgkin lymphoma is to cure the cancer with the fewest possible short and long-term side effects. This is particularly important in childhood Hodgkin lymphoma where cure rates are high. It’s important to get the balance right between curing the cancer and having the lowest risk of long-term side effects.

If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you may have. Written information is often provided to help explain things.

Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide whether it’s right for your child.

Treatment guidelines

Sometimes, clinical trials are not available for your child’s tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.

Follow-up care

About 90% of children who develop Hodgkin lymphoma are cured. When your child completes treatment, they will then go into a follow-up phase, seeing doctors and nurses in out-patient clinics usually for around five years. Clinic visits will be every 3 to 4 months to start with and there will be occasional scans, X-rays, and blood tests done for several years after completing treatment.

If the cancer comes back, a different course of treatment can be given. If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation.

Hodgkin lymphoma: Teenagers and young adults
of cancer, cancer types in teenagers and young adults

Treatment for Hodgkin lymphoma has a very good success rate and most people are cured.

Hodgkin lymphoma is a cancer of the lymphatic system, which is one of the body’s natural defences against infection.

Lymphomas, like all cancers, are a disease of the body’s cells. Normally cells in our body divide and grow in a controlled way. But sometimes cells keep dividing and grow out of control. This is how cancer develops.

In lymphomas, white blood cells called lymphocytes become abnormal and grow out of control. These lymphocytes can build up in one part of the body and form a lump (tumour).

There are 2 main types of lymphoma:

Hodgkin lymphoma non-Hodgkin lymphoma (NHL) 

Although these cancers are both lymphomas, they are different and need different treatments. Your doctors will do tests to find out which type you have.


Hodgkin lymphoma is a cancer of the lymphatic system, which is one of the body’s natural defences against infection.

Lymphomas, like all cancers, are a disease of the body’s cells. Normally cells in our body divide and grow in a controlled way. But sometimes cells keep dividing and grow out of control. This is how cancer develops.

In lymphomas, white blood cells called lymphocytes become abnormal and grow out of control. These lymphocytes can build up in one part of the body and form a lump (tumour).

There are 2 main types of lymphoma:

Hodgkin lymphoma non-Hodgkin lymphoma (NHL) 

Although these cancers are both lymphomas, they are different and need different treatments. Your doctors will do tests to find out which type you have.


Lymphomas, like all cancers, are a disease of the body’s cells. Normally cells in our body divide and grow in a controlled way. But sometimes cells keep dividing and grow out of control. This is how cancer develops.

In lymphomas, white blood cells called lymphocytes become abnormal and grow out of control. These lymphocytes can build up in one part of the body and form a lump (tumour).

There are 2 main types of lymphoma:

Hodgkin lymphoma non-Hodgkin lymphoma (NHL) 

Although these cancers are both lymphomas, they are different and need different treatments. Your doctors will do tests to find out which type you have.

Symptoms

One of the most common symptoms is having a painless lump. The lump is caused by swollen lymph nodes. There may be one or more lumps and these may be in your neck, armpit or groin.

Lumps can also be inside the body. A commonplace would be inside the chest and this can cause a cough or breathlessness.

Some people feel tired and lethargic with lymphoma. Itching of the skin is also quite common.

Some people with Hodgkin lymphoma have other symptoms such as high temperatures, very heavy sweats (especially at night) and unexplained weight loss. Doctors call these symptoms ‘B symptoms’.

Most of the symptoms that people get with lymphoma may also be caused by other illnesses. For example swollen lymph nodes, high temperatures and sweats may be caused by an infection. But if you have any of these symptoms or are worried that you may have Hodgkin lymphoma, go to your GP. They’ll examine you and refer you to a hospital if they think you need to see a specialist doctor.

Causes

It’s not known what causes Hodgkin lymphoma. Research is going on to try to find out. Remember, though, it isn’t anything that you’ve done.

Hodgkin lymphoma is one of the most common cancers in young people over the age of 10. About 1 in 6 of all cancers affecting young people between 15 and 24 is a Hodgkin lymphoma.

Hodgkin lymphoma isn’t infectious and can’t be passed on to other people or family members.

If you’re looking for information about Hodgkin lymphoma in people of all ages, read our general Hodgkin lymphoma section.

Huntington’s disease
of brain nerves and spinal cord

The damage to the brain gets worse over time. It can affect movement, cognition (perception, awareness, thinking, judgement) and mental health.



The condition gradually gets worse for around 10-25 years, until the person dies.

Early symptoms

Behavioural changes are often the first symptoms of Huntington’s disease. These changes often include:

a lack of emotions and not recognising the needs of others periods of aggression, excitement, depression, antisocial behaviour and anger apathy – causing a person to appear lazy or have a lack of interest in hygiene and self care difficulty concentrating on more than one task and handling complex situations irritability and impulsiveness

Speak to your GP if: you’re worried you might have early symptoms of Huntington’s disease, especially if there’s a history of the condition in your family

Later symptoms

Further symptoms of Huntington’s might include:

psychiatric problems – some people develop obsessive behaviours, delusional thoughts or behaviours, stubborness, lack of self awareness, or suicidal thoughts uncontrollable movements of the face, jerking, clicking or fidgety movements of the limbs and body difficulty eating because the mouth and throat muscles don’t work properly which can lead to choking and chest infections communication problems – difficulty putting thoughts into words and slurring of speech sexual problems – a loss of interest in sex or making inappropriate sexual demands balance problems

In the later stages of Huntington’s disease, the person will need full nursing care.

Death is usually from a secondary cause, like pneumonia or another infection.

You might find the palliative care section useful if you’re caring for someone who’s dying, or if you want to plan your end of life care.

Symptoms

People can start to show the symptoms of Huntington’s disease at almost any age. Most will develop problems between the ages of 30 and 50.

The condition gradually gets worse for around 10-25 years, until the person dies.

Early symptoms

Behavioural changes are often the first symptoms of Huntington’s disease. These changes often include:

a lack of emotions and not recognising the needs of others periods of aggression, excitement, depression, antisocial behaviour and anger apathy – causing a person to appear lazy or have a lack of interest in hygiene and self care difficulty concentrating on more than one task and handling complex situations irritability and impulsiveness

Speak to your GP if: you’re worried you might have early symptoms of Huntington’s disease, especially if there’s a history of the condition in your family

Later symptoms

Further symptoms of Huntington’s might include:

psychiatric problems – some people develop obsessive behaviours, delusional thoughts or behaviours, stubborness, lack of self awareness, or suicidal thoughts uncontrollable movements of the face, jerking, clicking or fidgety movements of the limbs and body difficulty eating because the mouth and throat muscles don’t work properly which can lead to choking and chest infections communication problems – difficulty putting thoughts into words and slurring of speech sexual problems – a loss of interest in sex or making inappropriate sexual demands balance problems

In the later stages of Huntington’s disease, the person will need full nursing care.

Death is usually from a secondary cause, like pneumonia or another infection.

You might find the palliative care section useful if you’re caring for someone who’s dying, or if you want to plan your end of life care.

Causes

Huntington’s disease is caused by a faulty gene. Cells in parts of the brain are very sensitive to the effects of the faulty gene. This makes them function poorly and eventually die.

A parent with the Huntington’s disease gene has one good copy of the gene and one faulty copy.

This means there’s a:

50:50 chance that each of their children will develop Huntington’s disease – affected children can pass the gene to children they may have 50:50 chance that each of their children won’t develop Huntington’s disease – unaffected children can’t pass the gene to children they may have

It’s difficult to predict how old a child will be when they develop the condition if they inherit the abnormal gene.

In around 3% of cases of Huntington’s disease, there’s no obvious family history of the condition. This could be because relatives with the condition died before they were diagnosed with it. In rare cases, it’s due to a new fault in the gene that causes Huntington’s disease.

Diagnoses

If you have symptoms of Huntington’s disease, your GP will refer you to a specialist clinician.

The specialist will ask about your symptoms to:

see if it’s likely you have Huntington’s disease rule out similar conditions

They’ll examine you and test your thinking, eye movements, balance and walking. They’ll find out if you have any involuntary movements, such as chorea (fidgety or jerky movements).

Tests to diagnose Huntington’s disease

You might have genetic testing to confirm if you have Huntington’s disease if:

you’re showing symptoms of the condition and it runs in your family your doctor strongly suspects you have the condition

Diagnosis is based on the doctor recognising a number of factors like neurological examination, family history and genetic testing.

Genetic test The children of someone with Huntington’s disease can take a genetic test after the age of 18 to see whether they’ve inherited the faulty gene. It’s possible to have the gene change and still be healthy when you’re tested. This is known as “premanifest Huntington’s disease”. If they’ve inherited the faulty gene, they’ll develop Huntington’s disease, but it’s not possible to work out when. You can ask your GP or neurologist for an appointment at a genetic clinic. You’ll receive some counselling and blood samples will be taken. Your DNA from the blood samples will be analysed to see whether you have inherited the faulty gene. Scottish Huntington’s Association has a national youth service to help and support children and young people who are living within a Huntington’s family.

Brain scan In the early stages of Huntington’s disease, there may not be any specific changes on the brain scan. A doctor might use a brain scan if they’re concerned there may be other problems in addition to Huntington’s disease. A brain scan may involve having a computerised tomography (CT scan) or a magnetic resonance imaging (MRI) scan.

Getting tested in pregnancy If you’re pregnant and know you have the Huntington’s disease gene, it’s possible for your unborn baby to be tested during pregnancy at 11 weeks. You can discuss this with a genetic counselling team.

Preimplantation genetic diagnosis Preimplantation genetic diagnosis can be used when one partner is known to have or is at risk of having the faulty gene. It involves having in vitro fertilisation (IVF) treatment. The embryo is genetically tested to make sure it doesn’t have the faulty gene before being implanted into the womb.

Should I get tested?

Not everyone wants to know if they’ve inherited the faulty gene. It’s a personal choice.

Some people say they would rather not know because they want to enjoy their life and they may die of other causes before the condition develops.

If you’re considering genetic testing, your GP will refer you to a genetic counsellor first.

Treatments

There’s no cure for Huntington’s disease. Medication and therapies can help treat some of the symptoms.

Speech and language therapy and occupational therapy, can help with communication and day-to-day living.

Regular exercise is also very important. People who are active tend to feel much better physically and mentally than those who don’t.

Hyperglycaemia (high blood sugar)
of blood and lymph

It can occasionally affect people who don’t have diabetes, but usually only people who are seriously ill, such as those who have recently had a stroke or heart attack, or have a severe infection.

Hyperglycaemia shouldn’t be confused with hypoglycaemia, which is when a person’s blood sugar level drops too low.

This information focuses on hyperglycaemia in people with diabetes.


Hyperglycaemia shouldn’t be confused with hypoglycaemia, which is when a person’s blood sugar level drops too low.

This information focuses on hyperglycaemia in people with diabetes.


This information focuses on hyperglycaemia in people with diabetes.

Symptoms

Symptoms of hyperglycaemia in people with diabetes tend to develop slowly over a few days or weeks. In some cases, there may be no symptoms until the blood sugar level is very high.

Symptoms of hyperglycaemia include:

increased thirst and a dry mouth needing to pee frequently tiredness blurred vision unintentional weight loss recurrent infections, such as thrush, bladder infections (cystitis) and skin infections

Symptoms of hyperglycaemia can also be due to undiagnosed diabetes, so see your GP if this applies to you. You can have a test to check for the condition.

Causes

A variety of things can trigger an increase in blood sugar level in people with diabetes, including:

stress an illness, such as a cold eating too much, such as snacking between meals a lack of exercise  dehydration missing a dose of your diabetes medication, or taking an incorrect dose over-treating an episode of hypoglycaemia (low blood sugar) taking certain medicines, such as steroid medication

Occasional episodes of hyperglycaemia can also occur in children and young adults during growth spurts.

Treatments

If you’ve been diagnosed with diabetes and you have symptoms of hyperglycaemia, follow the advice your care team has given you to reduce your blood sugar level.

If you’re not sure what to do, contact your GP or care team.

You may be advised to:

change your diet – for example, you may be advised to avoid foods that cause your blood sugar levels to rise, such as cakes or sugary drinks drink plenty of sugar-free fluids – this can help if you’re dehydrated exercise more often – gentle, regular exercise such as walking can often lower your blood sugar level, particularly if it helps you lose weight if you use insulin, adjust your dose – your care team can give you specific advice about how to do this

You may also be advised to monitor your blood sugar level more closely, or test your blood or urine for substances called ketones (associated with diabetic ketoacidosis).

Until your blood sugar level is back under control, watch out for additional symptoms that could be a sign of a more serious condition (see below).


Contact your diabetes care team immediately if you have a high blood sugar level and experience the following symptoms:

feeling or being sick abdominal (tummy) pain  rapid, deep breathing signs of dehydration, such as a headache, dry skin and a weak, rapid heartbeat difficulty staying awake

These symptoms could be a sign of diabetic ketoacidosis or a hyperosmolar hyperglycaemic state (see above) and you may need to be looked after in hospital.

Preventions

There are simple ways to reduce your risk of severe or prolonged hyperglycaemia:

Be careful what you eat – be particularly aware of how snacking and eating sugary foods or carbohydrates can affect your blood sugar level. Stick to your treatment plan – remember to take your insulin or other diabetes medications as recommended by your care team. Be as active as possible – getting regular exercise can help stop your blood sugar level rising, but you should check with your doctor first if you’re taking diabetes medication, as some medicines can lead to hypoglycaemia if you exercise too much Take extra care when you’re ill – your care team can provide you with some “sick day rules” that outline what you can do to keep your blood sugar level under control during an illness. Monitor your blood sugar level – your care team may suggest using a device to check your level at home, so you can spot an increase early and take steps to stop it.

Hyperhidrosis
of skin hair and nails

Hyperhidrosis is a common condition in which a person sweats excessively.

The sweating may affect the whole of your body, or it may only affect certain areas. Commonly affected areas include the:

armpits palms of your hands soles of your feet face and chest groin

Both sides of the body are usually affected equally – for example, both feet or both hands.

The sweating doesn’t usually pose a serious threat to your health, but it can be embarrassing and distressing. It can also have a negative impact on your quality of life and may lead to feelings of depression and anxiety.

Read more about the complications of hyperhidrosis.

Causes

In many cases, hyperhidrosis has no obvious cause and is thought to be the result of a problem with the part of the nervous system that controls sweating. This is known as primary hyperhidrosis.

Hyperhidrosis that does have an identifiable cause is known as secondary hyperhidrosis. This can have many different triggers, including:

pregnancy or the menopause anxiety certain medications low blood sugar (hypoglycaemia) an overactive thyroid gland (hyperthyroidism) infections

Read more about the causes of hyperhidrosis.


Hyperhidrosis can be divided into 2 types, depending on whether an obvious cause can be identified. These are known as primary and secondary hyperhidrosis.

Treatments

Visit your GP if you feel that your sweating is interfering with your daily activities, or you suddenly start sweating excessively.

Many people with hyperhidrosis are too embarrassed to seek medical help or believe that nothing can be done to improve it. But treatment is available.

Also visit your GP if you are having night sweats, because it can sometimes be a sign of something more serious.

Your GP will usually be able to diagnose hyperhidrosis based on your symptoms, although occasionally you may need blood and urine tests to check for an underlying cause (see below).


Excessive sweating can be challenging to treat and it may take a while to find a treatment right for you. 

Doctors usually recommend starting with the least invasive treatment first, such as powerful antiperspirants. Lifestyle changes may also help, including:

wearing loose and light clothes avoiding triggers, such as alcohol and spicy foods, that could make your sweating worse wearing black or white clothes to help minimise the signs of sweating

If this doesn’t help, you may be advised to try treatments such as iontophoresis (the affected area is treated with a weak electric current passed through water or a wet pad), botulinum toxin injections, and even surgery in a few cases.

Hyperhidrosis is usually a long-term condition, but some people experience an improvement with time and the treatments available can often keep the problem under control.

Read more about treating hyperhidrosis.


Hyperhidrosis can be challenging to treat and it may take a while to find the best treatment for you. Less invasive treatments will usually be recommended first.


Feelings of anxiety are not directly responsible for causing primary hyperhidrosis, but they can make the situation worse and create a vicious cycle.

You may feel self-conscious, which can trigger anxiety in certain situations, such as when meeting new people or being in a crowded room. The anxiety can make the sweating worse.

If your anxiety is making your sweating worse, a type of talking therapy called cognitive behavioural therapy (CBT) might help. Medication for anxiety is not usually recommended because it can make sweating worse.

Complications

Hyperhidrosis doesn’t usually pose a serious threat to your health, but it can sometimes lead to physical and emotional problems.

Hypoglycaemia (low blood sugar)
of blood and lymph

Hypoglycaemia, or a “hypo”, is an abnormally low level of glucose in your blood (less than four millimoles per litre).

When your glucose (sugar) level is too low, your body doesn’t have enough energy to carry out its activities.

Hypoglycaemia is most commonly associated with diabetes, and mainly occurs if someone with diabetes takes too much insulin, misses a meal or exercises too hard.

In rare cases, it’s possible for a person who doesn’t have diabetes to experience hypoglycaemia. It can be triggered by malnutrition, binge drinking or certain conditions, such as Addison’s disease.

Read more about the causes of hypoglycaemia

Symptoms

Most people will have some warning that their blood glucose levels are too low, which gives them time to correct them. Symptoms usually occur when blood sugar levels fall below four millimoles (mmol) per litre.

Typical early warning signs are feeling hungry, trembling or shakiness, and sweating. In more severe cases, you may also feel confused and have difficulty concentrating. In very severe cases, a person experiencing hypoglycaemia can lose consciousness.

It’s also possible for hypoglycaemia to occur during sleep, which can cause excess sweating, disturbed sleep, and feeling tired and confused upon waking.

Read more about the symptoms of hypoglycaemia


The symptoms of hypoglycaemia usually begin when your blood glucose level drops below four millimoles (mmol) per litre.

If you have diabetes, particularly if it’s treated with insulin, you may be advised to use a small device called a blood glucose meter to regularly check your blood glucose levels.

Symptoms can vary from person to person, and it’s important to be aware of the early warning signs so you can treat them.

Signs and symptoms of hypoglycaemia can include:

feeling hungry sweating dizziness tiredness (fatigue) blurred vision trembling or shakiness going pale fast pulse or palpitations tingling lips irritability difficulty concentrating confusion disorderly or irrational behaviour, which may be mistaken for drunkenness

If hypoglycaemia isn’t treated promptly and your blood glucose levels drop low enough, you may become drowsy or even lose consciousness.

Most people with insulin-treated diabetes notice that the symptoms of hypoglycaemia change and become less obvious the longer they live with the condition.

For some people, the warning symptoms become greatly reduced, putting them at significant risk of having severe episodes where they’re dependent on others for help.

Let your diabetes care team know if you develop this problem as your treatment may need to be changed to reduce the risk.

Read more about how hypoglycaemia is treated

Causes

In most cases, hypoglycaemia affects people with diabetes, although more rarely it can also occur as a result of other underlying conditions.

Treatments

In most cases, you can treat hypoglycaemia yourself when you recognise the symptoms.


The immediate treatment for hypoglycaemia is to have some sugary food or drink (about 15 to 20g of rapidly acting carbohydrate) to end the attack.

For example, this could be:

a glass of fruit juice or non-diet soft drink between three and five dextrose tablets a handful of sweets

At first you should avoid fatty foods and drinks, such as chocolate and milk, because they don’t usually contain as much sugar and the sugar they do contain may be absorbed more slowly.

After having something sugary, you should have a longer-acting carbohydrate food, such as a few biscuits, a cereal bar, a piece of fruit or a sandwich.

It will usually take around 15 minutes to recover from a mild episode of hypoglycaemia. If you have a blood glucose meter, measure your blood sugar again after 15 to 20 minutes. If it’s still too low (below 4mmol), you should have some more sugary food or a drink before testing your levels again in another 15 to 20 minutes.

When treating someone else with hypoglycaemia, if the above treatment isn’t effective, you may be able to help them by applying glucose gel (or honey, treacle or jam if glucose gel isn’t available) to the inside of their cheeks, and gently massaging the outside of their cheeks.

It may take 10 to 15 minutes before they feel better. This shouldn’t be done if the person is drowsy or unconscious because of the risk of choking.

If you have several episodes of hypoglycaemia a week, you should contact your diabetes care team to find out the underlying cause. Your medication may need to be adjusted, or there may be another condition causing hypoglycaemia that needs to be treated.


If you’re at risk of hypoglycaemia, you should carry sugary food and drink with you at all times to treat mild cases as soon as possible.

If you have diabetes, particularly type 1 diabetes, your doctor may recommend medications such as glucose gel to carry with you. This can be used to treat hypoglycaemia that doesn’t respond to normal treatment.

If you’re being treated with insulin, you’ll usually be given a kit that contains an injection of a medication called glucagon. Family members or your carer can be trained to carry out the injection, which should be used if you lose consciousness because of severe hypoglycaemia.

Preventions

If you have diabetes that requires treatment with insulin, the safest way to avoid hypoglycaemia is to regularly check your blood sugar and learn to recognise the early symptoms.

Missing meals or snacks or eating less carbohydrate than planned can increase your risk of hypoglycaemia. You should be careful when drinking alcohol as it can also cause hypoglycaemia, sometimes many hours after drinking.

Exercise or activity is another potential cause, and you should have a plan for dealing with this, such as eating carbohydrate before, during or after exercise, or adjusting your insulin dose.

You should also make sure you regularly change where you inject insulin as the amount of insulin your body absorbs can differ depending on where it’s injected.

Always carry rapid-acting carbohydrate with you, such as glucose tablets, a carton of fruit juice (one that contains sugar), or some sweets in case you feel symptoms coming on or your blood glucose level is low.

Make sure your friends and family know about your diabetes and the risk of hypoglycaemia. It may also help to carry some form of identification that lets people know about your condition in an emergency.

When hypoglycaemia occurs as the result of an underlying condition other than diabetes, the condition will need to be treated to prevent a further hypo.

Read more about preventing hypoglycaemia


If you have diabetes, sticking to your medication plan and eating regular meals can help prevent hypoglycaemia.

It’s also important to monitor your blood glucose levels.


It’s important to avoid recurrent hypoglycaemia during the night (nocturnal hypoglycaemia) as it can reduce the early symptoms of daytime episodes.

If you experience nocturnal hypoglycaemia, you can try:

keeping something sugary by your bedside having a snack before bedtime, such as biscuits and milk checking your blood glucose levels between 3am and 4am, when hypoglycaemia is most likely to occur

Idiopathic pulmonary fibrosis
of lungs and airways

Idiopathic pulmonary fibrosis (IPF) is a condition in which the lungs become scarred and breathing becomes increasingly difficult.

It’s not clear what causes it, but it usually affects people around 70-75 years of age and is rare in people under 50.

Several treatments can help reduce the rate at which IPF gets worse, but there’s currently no treatment that can stop or reverse the scarring of the lungs.

Symptoms

The symptoms of IPF tend to develop gradually and get slowly worse over time.

Symptoms can include:

shortness of breath a persistent dry cough tiredness loss of appetite and weight loss rounded and swollen fingertips (clubbed fingers)

Many people ignore their breathlessness at first and blame it on getting old or being out of shape. But eventually even light activity such as getting dressed can cause shortness of breath.


The most common symptom of idiopathic pulmonary fibrosis (IPF) is shortness of breath, often when physically active, which can get worse over time.

At first, many people ignore their breathlessness (especially older patients) and blame it on getting old or being out of shape. But as the disease progresses and lung damage becomes more severe, even light activity like getting dressed or having a shower can cause breathlessness.

Other symptoms of pulmonary fibrosis include:

a persistent dry cough tiredness loss of appetite and weight loss

In up to half of all cases, there is also a change in the shape of the finger and toenails. This thickening of tissue at the base of the finger and toenails is known as digital clubbing. The exact cause of clubbing is unknown, but it can occur in people with various chest and heart diseases.

Causes

In people with IPF, the tiny air sacs in the lungs (alveoli) become damaged and increasingly scarred. This causes the lungs to become stiff and means it’s difficult for oxygen to get into the blood.

The reason this happens isn’t clear. Idiopathic means the cause is unknown.

IPF has been linked to:

exposure to certain types of dust, such as metal or wood dust viral infections a family history of IPF – around 1 in 20 people with IPF has another family member with the condition gastro-oesophageal reflux disease (GORD)  smoking

But it’s not known whether some of these factors directly cause IPF.


The exact cause of idiopathic pulmonary fibrosis (IPF) is not known. Idiopathic means having no known cause.

The current theory is that IPF is triggered when cells that line the lung alveoli (air sacs) become damaged by exposure to one of several substances or viruses.

The damaged cells try to repair themselves but the process becomes uncontrolled, resulting in thickening and scarring (fibrosis) of the alveoli and surrounding lung tissue. The amount of oxygen that can pass from the lungs into the blood is then significantly reduced.

Diagnoses

Idiopathic pulmonary fibrosis (IPF) can be hard to diagnose because its symptoms are similar to other lung conditions, such as chronic obstructive pulmonary disease (COPD).

Your GP can refer you to hospital specialists for a number of tests to help rule out other conditions and confirm the diagnosis.

The checks and tests you may have include:

Medical history and examination

Breathing and blood tests

Chest X-ray and CT scan

Bronchoscopy

Lung biopsy


Lung function tests (also called pulmonary function tests) assess how well your lungs work and can help indicate what the problem may be.

These tests measure:

how quickly you can move air in and out of your lungs how much air your lungs can hold how well your lungs transfer oxygen into your blood and remove carbon dioxide from it (this can be checked using a blood test)

A commonly used lung function test is spirometry. During the test, you breathe into a mouthpiece that’s attached to a monitor.

Treatments

See your GP if you’ve struggled with your breathing for a while or have had a cough for more than three weeks.

These symptoms aren’t normal and shouldn’t be ignored.

If your GP thinks you could have a lung condition such as IPF, they can refer you to a hospital specialist for tests such as:

breathing (lung function) tests blood tests a chest X-ray and computerised tomography (CT) scan a lung biopsy (where a small piece of lung tissue is removed during keyhole surgery so it can be analysed)

Read more about the tests for idiopathic pulmonary fibrosis.


There’s currently no cure for IPF, but there are several treatments that can help relieve the symptoms and slow down its progression.

Treatments include:

self-care measures – such as stopping smoking, eating healthily and exercising regularly medication to reduce the rate at which scarring worsens – such as pirfenidone and nintedanib breathing oxygen through a mask – you can do this while you’re at home and/or while you’re out and about pulmonary rehabilitation – exercises and advice to help you breathe more easily a lung transplant – this is suitable in a few cases, although donor lungs are rare

Read more about how idiopathic pulmonary fibrosis is treated.


There’s currently no cure for idiopathic pulmonary fibrosis (IPF). The main aim of treatment is to relieve the symptoms as much as possible and slow down its progression.

The main treatments are:

Self-care

Medication

Oxygen support

Pulmonary rehabilitation

Lung transplant

As the condition becomes more advanced, end of life (palliative) care will be offered.