Diabetes: the facts

As the incidence of diabetes increases within the UK population, check out the facts about the condition and how to cope with the symptoms.

Diabetes is a condition with a rapidly increasing incidence, particularly in Western societies. In 1998, there were 1.2 million people with diabetes in England and Wales combined. By 2004, there were 1.3 million people in England alone.

What is it?
Insulin is a hormone, produced by the pancreas, which moves sugar (glucose) from the bloodstream into the cells, where it is used to make energy. In diabetes, glucose accumulates in the blood, due to either an absence of insulin, or a resistance to the activity of insulin.

There are 2 distinct types of diabetes:
Type 1 diabetes This is due to failure of insulin production by the pancreas, due to destruction of the insulin-producing cells by antibodies produced by the body's own immune system. It is therefore classified as an auto-immune disorder. This type of diabetes is most common in children and young adults, and only rarely starts after the age of 35. Type 1 diabetes needs treatment with insulin, which at the present time has to be given daily by injection.

Type 2 diabetes This is much more common than type 1, and tends to occur in an older age group. It is this type of diabetes that has increased in incidence so dramatically over recent years. There is no failure of insulin production, but the body develops a resistance to the action of insulin, and it is thought that obesity is a major factor in the development of insulin resistance. This type of diabetes may be controlled by dietary measures alone, or may require tablets, or may sometimes require insulin also.

What are the symptoms?
The presenting symptoms are similar for both types of diabetes, but in Type 1, the symptoms come on quite quickly, over a period of a few weeks, and are acute. In Type 2, the symptoms are less severe, and come on more slowly, so may have been present for months or years before the sufferer goes to the doctor.
Typical symptoms include:
Thirst
Passing urine frequently, and in large quantities
Extreme tiredness
Weight loss
Blurred vision
Frequent minor infections such as boils and thrush

The diagnosis is confirmed by measurement of blood sugar (glucose) levels.

How is it treated?
It is very important for diabetics to be well-informed about their condition, and actively involved in all areas of diabetes care. Newly diagnosed diabetics should be given lots of information, and should be seen regularly by doctors and specialist diabetic nurses, until they have got to grips with the diagnosis, their lifestyle changes and their treatment plan. Once routines have become established, the patient should hopefully be 'in charge' of their diabetes, with approximately twice-yearly review by a health professional.

Dietary measures These are an important part of diabetes management, though, mercifully, the strict diabetic diet with 'portion' counting has been consigned to history. It is important to limit refined sugar in all forms, but otherwise the dietary regime is a healthy balanced diet, high in complex carbohydrates and fibre. It is also important not to increase the fat content to compensate for the sugar restriction, as diabetes is associated with an increased risk of heart disease. The GI Diet is good for diabetics because they stabilise blood sugar levels.

Type 1 Treatment is lifelong, and consists of daily insulin injections, combined with dietary measures. All newly diagnosed patients dread the idea of injecting themselves every day (and probably more than once a day), but most people get used to it remarkably quickly, and it soon becomes incorporated into their daily routine. The insulin is injected just beneath the skin of the lower abdomen or thighs. Some patients have a continuous insulin infusion from a portable pump.

Type 2 For many Type 2 sufferers, sugar restriction and weight loss are all that are needed to stabilise blood sugar levels. Others need a combination of dietary measures and tablets, and a relatively small number eventually need a small amount of insulin as well.

How is blood sugar monitored?
Blood sugar monitoring is an important part of achieving good diabetic control for all diabetics. Diabetics monitor their own sugar levels with regular self-testing. A pricking device is used to obtain a drop of blood from the pulp of a finger, and this is placed on a testing strip. The blood sugar reading can be read from a colour chart, or the strip can be inserted into a meter that gives a numerical read-out.

The frequency of testing is dictated by the stability of blood sugar control. Type 1 patients need to test more often than Type 2 patients.

A laboratory test called HbA1C is used by doctors to measure the average blood sugar over the previous 3 months. All patients are encouraged to know their most recent 'A1C' (pronounced A one C) level, with the aim of achieving a level below 7.

Good blood sugar control significantly reduces the long-term health risks associated with diabetes.

Blood sugar monitoring is also important, especially in Type 1 diabetics, to prevent episodes of hypoglycaemia (low blood sugar).

Hypoglycaemia is a serious complication of taking blood sugar lowering medication, especially insulin. Alcohol also increases the risk of hypoglycaemia. Hypoglycaemia can result in coma or death, so it is very important for diabetics and their families to learn how to recognise a hypoglycaemic attack, and be able to act quickly. The symptoms of hypoglycaemia can come on very quickly, so diabetics should carry a sugar source that they can take at the first sign of an attack.

Symptoms of hypoglycaemia include sweating, weakness, confusion, agitation, aggression, trembling, dizziness and lack of co-ordination.

What other checks do diabetics need?
Diabetics are at increased risk of a number of other medical problems, but the risks are reduced by good diabetic control, and by careful monitoring of other aspects of their health, particularly blood pressure and cholesterol levels. Complications of poorly controlled diabetes include heart attacks, strokes and other circulatory diseases, loss of vision, kidney disease and loss of function of the nerves supplying the feet (neuropathy). In addition to regular checks of HbA1C, blood pressure and cholesterol, diabetics should have yearly blood and urine tests to monitor the kidneys, annual eye examinations (retinopathy screening) at an accredited centre, and regular foot assessments by a chiropodist. Regular checks of this kind have significantly reduced the incidence of diabetic complications. Smoking markedly increases the risk of many complications, so all diabetics are strongly advised to stop smoking.

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