First Steps to living with Diabetes (Types 1 and 2)

Simon Atkins

• Publisher: Lion Books
• Year: 2016
• ISBN:
  9780745970448
• Topic: Personal Development
• Subtopic: Self Improvement

What is Diabetes, and what are the differences between Types 1 and 2? What symptoms should you look out for, and what can you do to ensure you don't become a sufferer? If you have been diagnosed, what do you need to know? And what if you have a child with the condition? Dr Simon Atkins succinctly sets out the facts about this increasingly common condition. Whether you are concerned for yourself or someone else, First Steps to living with Diabetes will advise you on how it is diagnosed, conventional medical treatments, and the lifestyle changes that can help prevent Type 2 Diabetes.

1

What is diabetes?

Diabetes mellitus – to give it its full name – is a common, lifelong medical condition in which people have abnormally high levels of blood sugar. If it’s not controlled, it affects many of the body’s vital organs because of the damage it causes to nerves and blood vessels.

It is a disease that has an impact on the body’s metabolism by affecting the control of levels of sugar in the blood. If you’d like to know more about the nitty-gritty of the science behind the condition, then head for Appendix 1, where you’ll find a bit more about the biology of the hormone insulin and how, when its mechanisms become faulty, people can develop diabetes.

Diabetes by numbers

British diabetes charities reckon that there are currently 3 million people in the UK with one of the two types of diabetes. And the International Diabetes Federation reports that it affects around 387 million people worldwide, with the following distribution across the different regions of the globe:

Figures from the International Diabetes Federation Report 2014 (www.idf.org)

They also estimate that a whopping 46 per cent of cases of diabetes are still undiagnosed and by 2035 there will be another 205 million people around the world who have the diagnosis.

Many in the “undiagnosed” group have what is known as pre-diabetes; the remainder already have either the Type 1 or Type 2 form of diabetes itself and just don’t know it yet.

Pre-diabetes

Pre-diabetes is also called borderline diabetes because people with this have higher than normal levels of blood sugar but the readings don’t yet meet the criteria for full-on diabetes. People in this category are thought to be likely to go on to develop Type 2 diabetes (see below) over the following ten years.

This is by no means a foregone conclusion, though, and research so far suggests that only 50 per cent of people with pre-diabetes will go on to develop diabetes. As a result, there is some controversy about this “diagnosis” among medical experts around the world.

In the USA, for example, there are very definite criteria for its diagnosis (see table in Chapter 4), with those fitting the bill having intensive input from health professionals who not only encourage lifestyle improvements but may also prescribe the drug metformin which, as we’ll see in Chapter 8, is only used in the UK to treat definite diabetes. In fact, in the UK there are no agreed blood results for diagnosis of pre-diabetes and it is not recognized as an official diagnosis by the World Health Organization.

However, most doctors and nurses will advise people who fit the American criteria about lifestyle changes they could make to reduce their risk of developing Type 2 diabetes.

Type 1 diabetes

This is the less common variety of the disease, which affects around 1 in 300 people in the UK, accounting for around 10 per cent of all cases of diabetes. It typically arises in children and young adults, hence its previous names of childhood or juvenile diabetes and early-onset diabetes, and it is rare (although not impossible) to see a new diagnosis in people over the age of 40.

In this type of diabetes the pancreas stops making insulin and so there is a loss of control of blood sugar levels. Type 1 diabetes is therefore treated by making up for the body’s lack of this hormone with regular injections of insulin. This gives it another of its previous names: insulin-dependent diabetes.

It’s thought that Type 1 diabetes is an autoimmune disease in which a person’s immune system attacks part of their own body. This happens in a number of other well-known medical conditions such as rheumatoid arthritis. In Type 1 diabetes the immune system attacks the pancreas gland, with the direct result that it stops making insulin. It’s believed that this immune attack can be triggered by a virus infection.

Type 1 diabetes can run in families and the risk of developing it increases if your parents or siblings have the condition. And the more close relatives who have it, the higher the risk.

Type 2 diabetes

This is by far the most common form of diabetes, accounting for 90 per cent of cases and therefore equating to around 337.5 million people worldwide at current levels of diagnosis. It’s a disease that historically only affected people over the age of 40 (it used to be called adult-onset diabetes) but it’s now also being seen in young people and even children.

This is because, unlike Type 1 diabetes, which we’ve seen is an autoimmune disease, Type 2 diabetes is largely caused by obesity. We’re currently in the grip of an obesity epidemic affecting men, women, and children across the developed world. In fact, the World Health Organization estimated in 2014 that there were 1.9 billion overweight adults globally (39 per cent of the world’s adult population), with 6 million (13 per cent of adults) being obese.

The figures for children show that a staggering 42 million under-fives around the planet are either overweight or obese. It’s no wonder, then, that the number of people developing Type 2 diabetes is predicted to rise dramatically over the next 20 years.

There are two reasons why people develop Type 2 diabetes:

• reduced production of insulin
• insulin resistance, where cells become less responsive to the effects of the insulin that is produced.

It is treated with a combination of lifestyle advice, particularly aimed at helping people to lose weight, and medication. It used to be called non-insulin-dependent diabetes because insulin injections were very rarely used in treatment, but that is no longer the case. If pills and lifestyle changes don’t keep sugar levels under control in Type 2, then insulin may well be needed.

What is obesity?

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The definition of obesity is based on a person’s Body Mass Index (BMI), which is calculated from their height and weight measurements. It works for everyone, regardless of age and sex.

The calculation involves dividing a person’s weight in kilogrammes by the square of their height in metres. The World Health Organization uses the following levels for its definitions:

• BMI greater than or equal to 25 means you are overweight.
• BMI greater than or equal to 30 means you are obese.

Mythbuster

Diabetes isn’t really that serious.

Unfortunately, that couldn’t be further from the truth. Diabetes comes eighth in the World Health Organization’s list of Top Ten causes of death and it increases the risk of developing the top two on the list: heart disease and stroke.

2

What are the symptoms?

Spotting the symptoms of diabetes, be it Type 1 or Type 2, is crucial, as it means that treatment can be started as early as possible and the risks of developing the complications considered in Chapter 9 will be greatly reduced. Although there are many overlaps in the sets of symptoms produced by both types of diabetes, they each have some of their own unique features too. In this chapter we will look at both.

These symptoms will also depend on whether your body has too much or too little sugar whizzing around in the bloodstream at any one time. Even after diabetes is diagnosed, it’s important to be aware of the warning signs for both situations.

We will also look at the symptoms of diabetic ketoacidosis, a potentially life-threatening medical emergency.

Before diagnosis

The most common symptoms of diabetes are the same regardless of which type of the condition is triggering them. They are caused by the effects of high levels of sugar in the bloodstream and the loss of the usual mechanisms for allowing it to be taken up into cells to be used as energy.

In Type 1 diabetes, the symptoms present suddenly and most often in children and younger people. In Type 2, however, the onset tends to be much more gradual, occurring in adults who will generally, but not always, be on the obese end of the weight spectrum. The main early symptoms are:

• Polydipsia. This is the technical term for a severe and persistent thirst despite drinking decent volumes of fluid during the day. It can be accompanied by an ongoing feeling of having a dry mouth, which is not relieved by drinking more. It occurs when the level of glucose in the blood becomes too high for it to be reabsorbed in the kidneys and so it is passed out in urine, taking more water with it than would usually be passed. This causes dehydration and thirst, and is the cause of the next symptom below.
• Polyuria. This describes the need to pass abnormally large volumes of urine very frequently every day. Polyuria is diagnosed when people find themselves peeing out more than three litres of urine in a 24-hour period; a more usual output would range from one to two litres. It will invariably go hand in hand with polydipsia.
• Polyphagia. This is the term used to describe an increased appetite, which will usually accompany the other two symptoms above. This increase will be felt as a desire to eat more food, more often.
• Fatigue. The experience of feeling tired all the time (or TATT as we abbreviate it in the trade) is one of the most common reasons for people to visit their family doctor. It can have many causes, including anaemia, abnormal thyroid gland function, stress and depression, heavy drug and alcohol use, a busy non-stop life due to burning the candle at both ends or perhaps the recent arrival of a baby in the family, and, not surprisingly, persistent lack of sleep. It can also be triggered by diabetes, because cells are being starved of their main energy supply, glucose. One of the tests doctors will run when people are TATT is a check of blood glucose levels, especially if accompanied by the other symptoms listed above.
• Unexplained weight loss. Losing weight without dieting is another of those worrying problems that people consult family doctors about, which can have ma...

Table of contents

• Cover
• Dedication
• Title Page
• Copyright
• Contents
• Introduction
• 1 What is diabetes?
• 2 What are the symptoms?
• 3 What causes diabetes?
• 4 How is diabetes diagnosed?
• 5 Who is involved in your care?
• 6 Dealing with your diabetes
• 7 Lifestyle modifications
• 8 Medical treatments
• 9 Long-term implications
• 10 Special circumstances
• Appendix 1: Blood sugar biology
• Appendix 2: Useful resources
• Acknowledgments