What is diabetes? How diet, lifestyle and even ethnicity can affect DEADLY disease

We're in the middle of a diabetes epidemic as a nation, with 3m people suffering

DIABETES is a condition often associated with the elderly, but are they the only people in danger? Absolutely not, Dr Adam Simon explains.

 

Diabetes cases are said to have soared by 60 per cent in the last decade, and it now affects over 3 million people in the UK. According to studies undertaken by Diabetes UK, this number will rise to 5 million by 2025.

Worryingly, it is thought that there are 900,000 people in the UK who don’t yet know they already have diabetes. Dr Adam Simon, chief medical officer at PushDoctor.co.uk, has spoken to NewsNewsBlog.blogspot.com about what diabetes is, the difference between the types and how people can avoid it. 

 

What is diabetes? Diabetes is a disease where the level of glucose in the body is too high, either because the hormone Insulin, that allows the body to use the glucose as an energy source, is not produced, or the insulin is not working properly.

Insulin is made in the pancreas which is located in the upper central abdomen. When the body’s glucose level rises, the pancreas makes insulin which allows the glucose to pass into the body’s cells where it can be used as energy. 

Food is broken down in the intestine into fats, proteins and glucose. Glucose is our main energy source and our bodies normally keep glucose levels carefully controlled. When the glucose level falls between meals, insulin production falls and this keeps the glucose level in the blood balanced.

 

Newsnewsblog.blogspot.com spoke to Dr Adam about the condition and how to handle it

Explain the difference between Type 1 and Type 2There are two main types of diabetes Type 1 and Type 2. Eighty five per cent of people with diabetes have Type 2 diabetes and 15 per cent have Type 1.

Type 1: This tends to occur in children and young adults. In this case the body stops making insulin. The body cells can no longer access the glucose and the blood glucose level become very high. The body has to quickly find an alternative source of energy, and it starts breaking down fats and protein to try and use these for energy. This is not as good a source of energy as glucose. The lack of energy and the breaking down of these essential fats and proteins quickly makes people with Type 1 diabetes very unwell, unless they are given artificial insulin.

Type 2: This diabetes develops in a much slower fashion. Here the pancreas either makes too little insulin or the body can’t make use of the insulin that is produced. Type 2 diabetes was previously a disease common in older, overweight and inactive people. However, there are an increasing number of young people being diagnosed with Type 2 diabetes.

How do people get diabetes? Type 1 diabetes is caused by a mixture of genes, making you at risk of diabetes and autoantibodies. Autoantibodies are proteins produced by the immune system that start to attack normal parts of the body instead of fighting illness, in this case destroying the parts of the pancreas where insulin is made.

 

Even one's ethnicity can affect the chance of diabetes

The cause of the body’s immune system going wrong is not known, however it is possible certain viruses cause the immune system to malfunction. These autoantibodies are commonly found in those at risk, and in people as young as six months of age, however they are not present in every case of Type 1 diabetes.

It is not exactly known why Type 2 diabetes occurs however people with the following characteristics are more at risk of developing it:

1. Genetics. The risk of developing Type 2 diabetes is higher if you have a relative with Type 2 diabetes. The closer the relative the greater the risk. If one parent has Type 2 diabetes their children have a 30% chance of developing it.
2. Ethnicity. Certain ethnic groups are at greater risk of developing Type 2 diabetes. This includes people of Middle-Eastern, African, African-Caribbean, South Asian, Polynesian and American-Indian ancestry. 
3. Being Overweight. Those with a body mass index (BMI) of 30 or more, especially those women with a waist measuring more than 31.5 inches (80cm) or a man who has a waist measuring more than 37 inches (94cm) are at greater risk of developing Type 2 diabetes.
4. Age. Though it is increasing in younger people, Type 2 diabetes does not normally occur under the age of 40 and as you get older the risk increases, for example from 1 in 20 people over 65 to 1 in 5 people over the age of 80.

Can you get it from eating too much sugar? Indirectly, yes. If you eat too much sugar it is likely you will become overweight. This in turn increases the risk of developing Type 2 diabetes. 

Increasing exercise combined with a healthy diet has been shown to reduce the risk of developing Type 2 diabetes in people in high-risk groups (see question above).

 

What are the symptoms of diabetes?Though the symptoms are almost the same for Type 1 and Type 2 diabetes, Type 1 patients develop symptoms rapidly and become unwell over a matter of days. The start of Type 2 diabetes is gradual and the symptoms can be very mild at first, it can be months before the diagnosis is made. Common symptoms of diabetes are as follows:

• Unexplained weight loss
• Fatigue and lethargy 
• Being thirsty despite drinking lots of fluids
• Passing more water than usual 
• Recurrent  and prolonged infections (especially recurrent thrush infection)
• Blurred vision

People with Type 1 diabetes can become seriously unwell with dehydration and breathing too fast when it starts, and if left untreated it can potentially lead to a fatal coma.

Is there a link between alcohol and diabetes?There is no direct association between drinking within the recommended levels of alcohol intake and diabetes, however persistent alcohol abuse can lead to chronic pancreatitis which can lead to diabetes. 

Why is it that people who have diabetes need the toilet a lot? Imagine putting sugar onto a piece of damp kitchen roll. The water from the paper gets drawn into the sugar. The same thing happens in the kidneys. The high level of glucose (sugar) in the bloodstream leads to a high level of glucose passing into the kidneys. This then draws extra water into the kidneys (like the sugar on the damp paper) and then into the bladder.

 

Type 1 diabetes tends to occur in children and young adults

What is the implication of diabetes?Having diabetes means that you need to be more careful about your general health and wellbeing:

• Diet: You may need to alter your diet to ensure you are eating a healthy and balanced amount of food, aiming for a diet low in fat, sugar, and salt and high in fibre.
• Exercise: You need to regularly take part in physical activity. Ideally 30 minutes cycling or fast walking 5 times a week. If walking is not your thing any activity that makes you feel a little sweaty and out of breath will not just help with diabetes but also reduce your risk of heart attack and stroke.
• Smoking:  Smoking increases the risk of complications. If there was ever a good time to stop it would be today but definitely if diagnosed with diabetes. 
• Vaccination: Annual flu vaccination is vital unless there is a medical reason not to have it, as people with diabetes have a higher risk of experiencing complications from flu infection.

There are 3 main aims for the treatment of diabetes:

1. To maintain as normal a blood glucose as possible.
2. To reduce the chance of developing complications from health issues.
3. To detect complications as quickly as possible.

Treatment alongside a combination of lifestyle changes, healthy living, health awareness, medication and monitoring both by the patient and health professionals will reduce chances of complications or further illness from diabetes. 

All patients with diabetes should be regularly reviewed by a GP or practice nurse with a specialist interest in diabetes or their community/hospital diabetes service, depending on their health. Your GP will advise you on the best person to see for regular reviews, and how often you should be seeing them.

People with diabetes who are on medication are entitled to free prescriptions and eye examinations, and may be eligible for incapacity benefits depending on effect the diabetes has on their lives. 

Depending on the type of diabetes or the medication you are on, you may have to inform the DVLA about your diabetes and you must inform your vehicle insurer. Sexual problems are more common in diabetes but this is a subject many patients are embarrassed to talk about and suffer in silence. The good news is that these problems can often be easily treated by a GP or Diabetic team professional.

Does it make you more susceptible to cancer?Most people with diabetes live healthy lives. However as with many other conditions there is an increased risk of some cancers with diabetes. These include:

• Pancreatic cancer
• Liver cancer
• Womb (Endometrial) cancer
• Colon (Colorectal cancer)
• Stomach cancer
• Cervical cancer

There is some good news in that there appears to be a reduced chance of prostate cancer in Type 2 diabetes. 

 

People with Type 2 diabetes do have an increased risk of premature death       

Dr Adam Simon

How can you be tested for it? The World Health Organisation (WHO) now recommends that testing for diabetes involves a blood test for HbA1c or Glycosylated Haemoglobin.

This test assesses your average blood sugar level over the previous three months. An HbA1c reading of over 48 mmol/mol  or 6.5%, suggests diabetes is present. Levels just below this and between 5.7% and 6.4% indicate increased risk of diabetes (prediabetes), and the need for monitoring. 

What does it mean to live with diabetes? Living with diabetes may mean altering your lifestyle but you should hopefully still be able to enjoy all of your favourite hobbies and pastimes.

Being diagnosed with diabetes is an emotional time. It is very important that people are given good advice about how to live a normal and healthy life with diabetes and get a chance to ask all the questions they have.

GP’s and practice nurses are a good source of information and answer questions that suffers may have, including those which they may find embarrassing to ask.

Charities such as Diabetes UK (www.diabetes.org.uk) offer a fantastic amount of information and practical advice and host online support forums to connect people with diabetes. However it is vital that these are used in addition, rather than instead of medical advice from a qualified medical professional such as a GP.

Can you die from diabetes? Lots of people with Type 1 diabetes enjoy good health. However there is an increased risk of heart, kidney and eye disease and some people with Type 1 diabetes do die early. 

People with Type 2 diabetes do have an increased risk of premature death. The death rate from heart disease is up to 5 times higher for those with diabetes compared with non-diabetics. Leading a healthy lifestyle and ensuring that blood glucose, blood pressure and weight are all controlled in line with professional medical advice reduces the risk of complications and early death.

Can anyone, any age suffer from it? Yes. Type 1 diabetes usually affects children and young adults. Whilst type 2 diabetes can occur in children it is predominantly found in those over the age of 40 and the risk increases with age.

Can you be born with it - can you pass it onto your children if you have it? You can be born with genes that make it more likely that you will develop diabetes. If a relative has Type 1 or Type 2 diabetes you have increased risk of developing it. The closer the relative is, the greater the risk. If one parent has Type 2 diabetes their children have a 30% chance of developing it.

If you eat a lot of sugar when you're pregnant, can you give your children diabetes? No. Diabetes is not passed on by eating a lot of sugar. If you have a family history of diabetes, there is an increased chance that your children will have diabetes, as previously mentioned.

Can having diabetes put you at risk of getting other diseases? Diabetes increases the risk of other diseases and can cause complications.

Complications can include:

Short term - complications of having diabetes and therefore very high glucose levels include, diabetic coma and Hypoglycaemia (where blood sugars drop too low - often caused by too much diabetic medication). 

Long term - Eye disease (Retinopathy), Heart disease (Cardiovascular disease), Kidney disease (Nephropathy), Loss of sensation and circulation to nerves (Nephropathy), Foot ulcers (Neuropathy)

Having Diabetes can also increase the risk of other conditions, including: Coeliac disease, Thyroid disease, Muscular conditions, Dental problems, Pregnancy complications

Dr Adam Simon is chief medical officer at PushDoctor.co.uk, and a registered NHS GP. PushDoctor.co.uk is an online service which connects consumers to a UK network of over 7,000 GMC-registered UK General Practitioners (GPs) on the go, from 6am to 10pm, seven days per week, to enable patients to access expert medical advice which works around their busy lifestyles, wherever they are.