Belfast Telegraph

Friday 22 August 2014

Learning to read the warning signs of diabetes danger

Testing time: A glucose level test is carried out using a hand-held meter
Healthy advice: Professor Merlin Thomas
Dr Hamish Courtney

After revelations that a worryingly high number of people have pre-diabetes, Abi Jackson looks at why it's not too late for many of us to take action.

Type 2 diabetes recently hit the headlines again, with major new research – published in the British Medical Journal – revealing that some 14 million people in England alone now have pre-diabetes, three times higher than figures from 2006.

Numbers are believed to be on the rise for the rest of the UK, too, and experts are warning that lots of people may not be aware that it affects them. They're also warning of an associated surge in type 2 diabetes rates.

This is nothing new. In 2010, it was revealed that more than a million Britons could already have undiagnosed type 2, with the overall number of diagnosed diabetes cases expected to rise from three million to more than five million by 2030 – the vast majority being type 2, the form linked with weight and lifestyle. (Type 1 has no lifestyle link and is, instead, believed to be caused by a fault in the immune system, which leads to insulin-producing cells being destroyed. It tends to first appear before age 40 and particularly during childhood and makes up around 10% of all diabetes cases).

With type 2, insulin-producing cells are still present, but they're no longer producing enough insulin, or the insulin isn't working properly, which wreaks havoc with the body's blood glucose levels. Both types are serious and can lead to major complications if not managed well, including blindness, kidney and nerve damage and amputation.

So what is pre-diabetes? It basically means that your blood glucose levels have increased, but not quite enough that you officially have full-blown type 2. The good news, though, is there's a lot you can do about it.

"In about 80% of cases, we can prevent, or delay, type 2 diabetes," says Libby Bowling, clinical adviser at the charity Diabetes UK.

"So I think a key message to get across to people is that we've coined this phrase, 'pre-diabetes', because it's easy to understand, but it's unfortunate that it gives the impression it's then inevitable that we will go on to develop full-blown type 2.

"That's not the case. Actually, it's a bit of a wake-up call. You still have a lot in your power to prevent developing type 2 diabetes in full."

So what can you do?

Knowledge is power

Understanding diabetes is the first step towards tackling it. This means being aware who's at risk, taking steps to prevent it, and knowing how to manage it.

"Understanding type 2 is important, because at least a quarter of us will develop diabetes in our lifetime, mostly after the age of 60," says Professor Merlin Thomas, author of Understanding Type 2 Diabetes, which explores the subject in depth.

"It's not only common, it also has the potential to shorten, or ruin, lives. However, type 2 diabetes and its complications are readily preventable. It just takes clear understanding, good support, commitment and management, but it is possible."

While it mostly occurs in overweight people aged over 40, type 2 can sometimes develop in younger age groups, particularly among South Asian people, who are at higher risk.

Symptoms include increased thirst, increased need to urinate, blurred vision, extreme tiredness and genital itching, but the condition can sometimes creep up with little warning, so if you are at risk, ask your GP for a test. Want to find out more? Books like Prof Thomas's are a great reference point, while the Diabetes UK website is packed full of information. You can also speak to your GP, or practice nurse.

Eat a sensible, balanced diet

"If you have pre-diabetes, you are about 10 times more likely to get type 2 diabetes in the next five years," says Prof Thomas.

"But, although your risk of diabetes is increased, this also means the benefits of lifestyle and diet interventions are much greater."

In fact, the same lifestyle adjustments that can prevent type 2 are also crucial to managing it (while some may require medication, even insulin injections, sometimes lifestyle changes alone are enough), and may in some cases "get rid of" it altogether. And eating well needn't be too confusing, or unattainable.

"It really is as simple as following a healthy, balanced diet, and by that we mean a diet that is low in fat, salt and sugar and having at least five portions of fruit and vegetables a day," Libby Bowling explains.

Eat regular meals throughout the day, rather than fasting and then having one big meal, as this will help balance out your energy levels. There are lots of recipe ideas and useful diet tips on the charity's website.

And remember, you can still enjoy the occasional treat.

"The key is that we say 'low' fat and sugar, not 'no' fat and sugar. So that doesn't mean you can never eat treat foods, you just need to be careful about how much you're having and how regularly you're having them," says Bowling. Allowing yourself an occasional treat may help you achieve a healthy diet for life, rather than being stuck in the "all or nothing" trap.

Be active

"Keeping physically active can help in either maintaining your weight, or losing weight if you've got weight to lose," says Libby Bowling.

Weight control is a vital factor in preventing and managing type 2, but being active plays a wider role, too.

Moving your limbs, getting your heart pumping and your blood flowing all help keep the body in good working order, preventing complications and generally bringing about a sense of motivation to look after yourself and control over your condition.

But don't be put off by thinking that you're not capable of exercise. "The Department of Health recommends 30 minutes of moderate physical activity on five days of the week," says Bowling. "That means something that makes your heart beat a little faster and makes you a little breathless, but you can still hold a conversation.

"People often automatically think, 'Oh, I have to go to the gym', but there's a lot you can do – a brisk walk, the gardening, playing with the kids, running up the stairs. And you don't even have to do the 30 minutes all in one go; it could be a 15-minute walk to and from work, instead of getting public transport."

If you have mobility difficulties or any type of disability or illness which may make taking part in exercise trickier, ask your doctor or nurse for advice. Are there classes or fitness facilities in your area you could join?

Give yourself a helping hand

Sometimes, drugs and medicines are unavoidable. But, generally, we could all benefit from looking at our lifestyles overall and considering how things might be impacting our health.

This includes prioritising sleep, reducing stress and factoring in time for relaxation and leisure to keep our batteries charged.

Alcohol and smoking are not directly linked with type 2 diabetes, but it's still worth taking a sensible approach, which means drinking in moderation and not smoking.

"Alcohol can be high in calories, so if you drink a lot, you may end up putting on weight," says Bowling. "And smoking is linked with high blood pressure, and having high blood pressure increases your risk of type 2."

Drinking too much and smoking could also lead to other problems and impaired circulation, both of which won't do you any favours if you do develop diabetes.

'I thought I was going through depression'

Marie Storey (71) is retired and lives in Lisburn. She has one grown-up son. She says:

I was diagnosed with type 2 diabetes 10 years ago. It was just after my mother had died and I wasn't feeling in great shape.

I seemed to be suffering from chronic fatigue for months – I felt like I could fall asleep at my desk and I was also very thirsty. My friends kept telling me I should go to the doctor, but I didn't think I should; I thought I was going through mild depression.

Eventually, my friends persuaded me to go to the GP and she did a run of blood tests and then I got a phonecall telling me I had diabetes.

I was aware of diabetes, but I should have been more aware, because three of my aunts had type 2 diabetes as well as my paternal grandmother.

I was shocked to discover I had it, but not surprised. I was overweight and did a very sedentary job. My father had died four years before and mum became quite needy, so when I wasn't at work, I would visit her at the weekend.

The diagnosis was a bit of a relief, too. I went in for a talk with the doctor and we decided we would manage it with diet for a month before we moved on to medication.

I did wonder what kind of impact it would have on my life. It does involve lifestyle changes. I still get tired and I have developed a stomach condition called gastroparesis, which goes hand-in-hand with the diabetes. I now take medication – I'm on 13 different tablets a day. You have to be very aware of the different things that affect you because of this condition.

You need to be wary of heat. I went to Barcelona one year when the heat was nearly 40 degrees and I developed blisters on my feet, which bled and got infected.

That sent me into a hypoglycemic attack, but thankfully I was with friends who looked after me.

I wouldn't say I'm a model diabetic. I've lost weight and put a little too much back on.

But when you go shopping, you get very used to reading labels to find out what's in food."

'A healthy lifestyle is crucial to prevention'

Dr Hamish Courtney is a diabetic consultant for the Belfast Trust. He says:

I've been a diabetic consultant for 10 years now. I have seen a significant rise in type 2 diabetes over the last decade.

There is a genetic component to type 2 diabetes, but not to the extent that it would raise the numbers of patients drastically in the space of 10 years. For most people, it's a lifestyle factor.

In 2006, there were around 55,000 diabetes patients in Northern Ireland and, by 2011, there were more than 72,000.

Around 10% of these patients will have type 1 diabetes, so the rest have type 2. This is a global trend that is reflected locally.

Another thing we're seeing is younger people being diagnosed with the condition. It used to be mostly in people over 45, but the ages of people we are seeing are dropping.

Diabetes-awareness is certainly rising, which may account for some of the rise in numbers.

But diabetes can be asymptomatic. As it progresses, though, it will lead to typical symptoms such as thirst, fatigue and the need for the toilet.

High levels of sugar in the blood, which is what diabetes is, can lead to eye complications – blindness is a real risk if it's not picked up – kidney failure, foot problems, heart attacks and strokes.

People diagnosed with diabetes in Northern Ireland will undergo structured patient education – sessions informing them about diet. This lifestyle advice is the key to treating them.

Then patients may be put on medication, such as Metformin, which lowers the levels of sugar in the blood.

It's important to note that none of these things are inevitable. The risk of any of these things happening is significantly reduced with early diagnosis and proper care.

If a diabetes patient does significantly change their lifestyle and lose weight, then their diabetes can go into remission. They are more at risk of developing it again, though.

A healthy lifestyle and not getting overweight are the key things to not developing diabetes. It's not all about sugar in a diet, as many might think; the problem is calories.

The most important thing for people to do if they think they might be at risk of diabetes is visit their GP to have a simple glucose test performed."

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