Diabetes

Introduction

Diabetes is a metabolic disorder which develops when the body has too much sugar (glucose) in the blood, because the body is unable to use it properly. Diabetes can be triggered by being overweight, or it can be inherited or caused by other factors, such as severe viral infections in childhood, but the actual diabetes trigger is not yet understood. As a result, more and more people in our increasingly inactive and overweight society continue to develop diabetes.

What is diabetes?

In the UK, 2.3 million people have diabetes, and up to 750,000 more have the condition but don't know it, according to the research charity, Diabetes UK.

It's important to understand the potential risks, and also follow advice about treatment, if you have been diagnosed with diabetes. If it is not treated, it can damage the heart, kidneys, eyes, nerves, skin, limbs and joints.

When a healthy person's blood-sugar level rises, the pancreas (a gland behind the stomach) produces a hormone called insulin. Insulin moves glucose safely out of the blood and into cells, where the glucose is broken down and converted into energy.

In people with diabetes, the body fails to produce enough insulin, or the body does not react properly to the insulin it does produce (insulin resistance).

The resulting high blood-sugar levels can cause serious health problems, so the sooner the illness is diagnosed, the better. People with diabetes can not currently be cured, but with the right treatment, blood sugar levels can be controlled so that complications don't arise.

There are three types of diabetes:

Type 1 (insulin-dependent diabetes)is not that common and is responsible for only around one in ten cases. People who develop this kind of diabetes are typically under 40, often developing the condition as teenagers.

Type 1 diabetes is an autoimmune disease which destroys the insulin-producing beta cells in an organ called the pancreas. It leaves the body able to make little or no insulin. The cause is currently unknown; it may be inherited or may result from an infection or environmental factors.

People with Type 1 diabetes need to take insulin regularly to control their blood-sugar levels and stay healthy. They also keep healthy by controlling their diets and taking regular exercise.

Type 2 or non-insulin-dependent diabetes.

Up to 95 per cent of people with diabetes have this form of the illness. Typically, Type 2 people are over 40 and overweight, although there are increasing numbers of children with the condition.

South Asian or Afro-Caribbean people in the UK are five times more likely to develop diabetes than the white population, and are particularly at risk at any age over 25.

With this type of diabetes, the body either does not make enough insulin, or the insulin you do produce does not work properly because the body has developed a resistance to it. The resistance is made worse by being overweight.

Type 2 diabetes can usually be managed by losing weight, exercising and, if necessary, taking anti-diabetic medication.

Gestational diabetes

Insulin resistance is common in all pregnant women, but only three to five per cent of all pregnancies result in gestational diabetes.

Some women cannot produce enough extra insulin to meet the demands of the growing baby, which can increase a pregnant woman's insulin requirements by two to three times.

Tests for gestational diabetes are made between 24 and 28 weeks into pregnancy. If you have people in your family with diabetes or other risk factors, such as being an older mother or being overweight or obese, your doctor may test you earlier (16 weeks).

Insulin takes sugar from your blood and transfers it to your cells, which use the sugar for energy. If you don't produce enough insulin, the sugar you get from food will build up in your blood and increase the level of blood sugars.

Gestational diabetes can generally be controlled by diet and exercise and goes away after the baby is born. It is rare for gestational diabetes to need medication to control it. However, if you do need insulin treatment, it will keep your blood sugar levels stable, protecting you and your baby.

After you have had your baby, your body will not have to produce so much insulin. If you've had medication to control your blood sugar levels, your doctor will reduce the dosage to the levels you had before you were pregnant.

Women who developed gestational diabetes should be seen by the diabetes pregnancy care team six weeks after having their baby.

The main symptoms of diabetes:

• Frequent need to urinate
• Feeling very thirsty
• Weight loss and/or muscle loss
• Tiredness

Other symptoms can include:

• Blurred vision
• Recurring skin, gum, bladder or vaginal infections, such as thrush
• Dry or itchy skin, especially around the genitals (vagina or penis)
• Nausea
• Increase in appetite
• Loss of sensation or tingling in hands or feet (neuropathy)

With Type 1 diabetes, symptoms typically come on rapidly over a few days or weeks. With Type 2 diabetes, there are often no or few symptoms, and they can develop gradually and mildly, so may not be noticed.

Are you at risk?

1. Does Type 1 diabetes run in your family?

If so, you're more at risk of developing it.

2. Are you over 40 and white, or over 25 and from an ethnic minority background?

The chance of developing Type 2 diabetes increases with age and is greater for Afro-Caribbean, Middle Eastern or South Asian people. Having a close relative with Type 2 diabetes also increases your chance of developing it too.

3. Are you overweight and inactive?

Type 2 diabetes is closely linked to being overweight and not getting enough exercise.

Eight out of ten people with Type 2 diabetes are overweight, with fat around the waist especially common. The more you weigh, the higher the risk of developing diabetes.

Check your waist measurement - if it's more than 31.5 inches (women), 35 inches (Asian men) or 37 inches (white men), you are more at risk.

Overweight women who have Polycystic Ovary Syndrome (PCOS) also have an increased chance of developing diabetes.

4. Have you had a heart attack, stroke, high blood pressure, high cholesterol or circulation problems?

People with diabetes are at greater risk of developing these conditions.

5. Have you given birth to a large baby or suffered from temporary diabetes in pregnancy?

These may increase your chances of developing diabetes in the future.

6. I think I may have diabetes - what should I do?

If some of these risk factors apply to you, or if you're experiencing any symptoms, ask your GP to test you for diabetes.

The test involves giving a urine sample. This is tested for glucose. You'll then be given a blood test which can more accurately diagnose if you have diabetes or not. The blood test may also give some idea of the cause.

Some people's glucose levels are too much on the borderline for a definite diagnosis. If this is the case, your GP will give you an Oral Glucose Tolerance Test in which you swallow a glucose drink and have your blood tested over a two-hour period to check how your body processes the glucose.

The dangers of diabetes and hyperglycaemia

If the illness is not kept under control, people with diabetes are at risk of various serious health problems, because excess glucose in the blood blocks up blood vessels or causes them to leak, damaging organs and nerves.

Even if the amount of glucose is only slightly too high and there are no short-term symptoms, the damage can show up in complications years later, so it's essential for people with diabetes to maintain a stable blood-sugar level.

When the level of sugar in the blood becomes too high, the body becomes hyperglycaemic. Sufferers become drowsy, dehydrated and have a frequent need to urinate. If insulin isn't taken, the body starts to break down fats instead of sugar for energy (ketoacidosis) and this can lead to unconsciousness or death.

What is hypoglycaemia?

A hypoglycaemic attack, or being 'hypo', happens when the body has too little blood sugar. For example if a person with diabetes has taken too much insulin or exercised too much.

The sufferer feels shaky or irritable and needs to raise their blood sugar levels by eating or drinking a swift-acting carbohydrate like a sugar cube or sugary drink.

Diabetes increases the likelihood of having a heart attack or stroke, because the blood vessels supplying the heart get blocked up by fatty deposits.

Diabetes can also cause impaired vision or blindness, kidney disease, impotence in men and skin ulcers

I've been diagnosed with diabetes - what now?

So long as you follow a treatment plan, you should be able to lead a healthy life and have a lower risk of complications.

Once you've been diagnosed, you'll be given regular check-ups with your GP. These will involve blood, urine and blood pressure tests and checks of your eyes, feet and nerves, as well as generally monitoring your treatment.

Being overweight makes it harder for the body to respond to insulin so achieving a healthier weight is important. Your GP's practice should be able to give you advice on any lifestyle changes that will help, such as losing weight, eating a healthier diet, getting more exercise and quitting smoking.

There's usually no need to cut out sugar or only eat 'diabetic' foods: the focus is more on eating healthily and building up activity levels in a sustainable, long-term way.

Once you start to lose weight, your medication may need to be readjusted. Diabetes UK has helpful information on foods.

How do I check my blood sugar levels?

People with either type of diabetes need to monitor their glucose levels, which are measured in millimoles per litre (mmol/l).

People with diabetes have to make sure they stay between the normal range of four to seven mmol/l before meals, and less than 10 mmol/l two hours after meals. This can be done with a simple test, where you prick your finger to get a drop of blood and put it on a testing strip to check the level of glucose using a special meter. There is also a urine test you can do yourself.

Treatments for type 1 diabetes

People with this type of diabetes need to take insulin for the rest of their lives. Most inject insulin two to four times every day - your GP or nurse will show you how.

There are alternative ways of taking insulin - for those who don't like needles, there's the insulin jet system, which forces a jet of insulin against the stomach, thighs or buttocks at such a high speed it enters the skin. Or there is insulin pump therapy, in which the insulin supply is inserted under the skin so injections are no longer needed. However, this treatment method is not widely available as yet in the UK.

Treatments for type 2 diabetes

Eating more healthily, losing weight if you're overweight and becoming more active can get blood sugar back into the normal range so that type 2 diabetes can be controlled.

Some people with this type of diabetes still need to take medication. GPs might prescribe tablets, injections of insulin or a combination of medicines.

Medication to reduce blood-sugar levels in type 2 diabetes.

Metformin - a drug to lower blood glucose by decreasing the amount of glucose your liver releases into the bloodstream. It also increases the sensitivity of your body's cells to insulin, so more glucose is taken into cells with the same amount of insulin in the bloodstream.

Metformin is generally the first medicine prescribed, if your blood glucose level is not controlled by changes in lifestyle (diet, exercise). It is a useful treatment if you are overweight, as it is less likely to cause an increase in weight than some other glucose-lowering drugs. You can take metformin with other blood sugar-lowering tablets if one tablet is not enough to control sugars in your bloodstream on its own.

Insulininjections help control your blood glucose levels. Not all people with type 2 diabetes need to take it. You may need insulin if your blood glucose is not satisfactorily controlled by tablets. How much insulin each person needs varies and some people will need to take insulin alongside tablets, such as metformin or a sulphonlyurea.

Side-effects of taking insulin by injection include weight gain, but this can generally be controlled by using insulin with metformin. Hypoglycaemia is another side-effect.

Sulphonylurea- a family of drugs used to increase the amount of insulin your pancreas makes. Sulphonylureas include glibenclamide, glimepride, gliquidone, glipizide, tolbutamide, and gliclazide. Such drugs are prescribed if you cannot tolerate Metformin due to side-effects or if you are overweight. The dosage starts low and can be increased until you maintain your blood sugar levels satisfactorily.

As this family of drugs increases the amount of insulin in your blood, low blood sugar (hypoglycaemia) can be a side-effect, but this is uncommon if you eat regular meals and don't drink alcohol. To treat hypoglycaemia, drink sugary beverages or eat sweets, then eat a snack high in starches, such as a sandwich or pasta.

Thiazolidinedionescome in two types: pioglitazone and rosiglitazone. Both lower blood sugars by increasing the sensitivity of your body's cells to insulin, so more glucose is taken up by cells for the same amount of insulin in your bloodstream. They are normally taken in conjunction with metformin or a sulphonylurea.

Both drugs carry a slight risk of liver and heart damage and have strict guidelines for their use. You will need to have blood tests every two months for the first year of treatment and periodically afterwards. Weight gain and hypoglycaemia are common side-effects of treatment with thiazolidinediones.

Nateglinide and repaglinideare not usually prescribed. They work in a similar way to sulphonylurea drugs. When you take them, they boost your insulin levels very quickly, but the effect of each dose doesn't last very long. You take them shortly before main meals, or don't take them if you miss a meal. Side-effects are similar to sulphonylurea drugs, with weight gain and hypoglycaemia as possible problems.

Acarbosedelays the absorption of carbohydrates that are broken down into glucose from digestive processes. As a result, the drug stops the peaks of glucose concentration that can occur after eating meals. It can be used with other glucose-lowering drugs, but digestive disturbances, such as diarrhoea, wind and bloating are fairly common side-effects.

Clickthrough information and support link:

Diabetes UK