World Diabetes Day is on 14 November. According to the International Diabetes Federation (IDF), if everybody in the world who have diabetes lived in one country it would be the 3rd most populous country in the world after China and India and as such, the IDF argues that diabetes poses a significant threat to global sustainable development.
SLOAN! Magazine spoke to Dr Jesse Kumar, Consultant Endocrinologist at Sevenoaks Medical Centre regarding the most frequently asked questions around this condition.
What is diabetes?
Diabetes is a metabolic condition, which is characterised by high blood glucose (sugar) levels, which in due course also affect fat and protein metabolism. In simple terms your body is not able to properly take up the glucose in your blood to utilise as energy. This is mainly because the key hormone ‘insulin’ is either lacking (type 1 diabetes) or unable to act properly (type 2 diabetes).
Type 1 diabetes occurs mostly in persons of a young age group (under 25 years) including children, and is an immunity-linked process, which destroys the insulin producing cells. Patients are usually of a normal or low weight.
Type 2 diabetes, which by far is the most common type of diabetes, is usually in adults above the age of 25 years. Patients tend to be overweight where the accumulation of fat tissue acts as a barrier to inhibit the insulin from acting properly (called insulin resistance). There is sometimes a slight overlap in the age of starting diabetes e.g. severely overweight children can develop type 2 diabetes due to the above damping down of insulin action.
What are the symptoms of diabetes?
Type 1 diabetes can present with symptoms of excessive thirst, urination, blurring of sight, weight loss and generalised tiredness. Sometimes an emergency condition called Diabetic Ketoacidosis can occur (due to rapid fat breakdown causing acid accumulation in the body) which requires hospital admission for treatment.
The symptoms of type 2 diabetes are usually thirst, excess urination as well as skin infections (boils, thrush etc.), tiredness and sometimes a slight black velvety discolouration under the armpits and neck folds (called acanthosis nigricans).
In addition the symptoms experienced with type 2 diabetes in particular, can be sometimes very mild causing late diagnosis and by the time of diagnosis the majority of patients have complications. This is unlike type 1 diabetes which is rapid in onset and very symptomatic with thirst, weight loss and excess urination.
How is diabetes diagnosed?
Diabetes can be diagnosed by a simple blood test called HbA1c or sometimes a fasting blood glucose level. Your GP will be able to do this. Rarely are further tests required but a specialist consultant may review if the diagnosis remains borderline (e.g. checking blood glucose readings after a sugary drink called Oral Glucose Tolerance Test) or if the type of diabetes remains unclear.
Early recognition is of utmost importance in type 2 diabetes as the symptoms can be very mild and sometimes missed. In the UK, we have implemented health checks for individuals aged 40 or over and screening for high-risk patient groups i.e. ethnic population, previous pregnancy diabetes etc.
What are the treatments for diabetes?
The treatments in diabetes are not only to sustain life but also to prevent complications (heart attacks, stokes, kidney failure, eye complications etc) on a long-term basis.
Type 1 diabetes treatment is always insulin (which is required to sustain life) as there is complete lack of insulin in this condition. This is because the insulin secreting cells in the pancreas are completely destroyed by the immune system. Insulin can be given in different ways to suit individual needs and also by a continuous insulin pump.
Type 2 diabetes can be treated in a variety of ways. The main initial treatment is lifestyle measures of a healthy diet, exercise and weight loss. The next step is usually Metformin (reduces insulin resistance and makes the insulin work better) and provides the best-known benefit to prevent complications. Metformin has been the subject of great research interest due to evidence suggesting it prevents cancer (obesity and type 2 diabetes can be a cancer risk).
Other drugs available include variety tablets which act on different organs e.g. sulfonylureas (which makes the pancreas produce insulin), PPAR gamma agonists (modifies fat metabolism and help insulin act better), DPP-4 inhibitors (helps insulin secretion) and also certain injections called GLP-1 analogues, which are very different from insulin and help weight loss (acts by suppressing appetite and help secreting insulin).
The above-mentioned drugs can be used in combination with or without insulin, which remains the last resort. There are many other new drug options, which are emerging, and also worth mentioning such as surgical treatments to promote weight loss in very severely overweight patients like gastric banding and bypass surgeries. It is shown that significant weight loss not only minimises the risk of heart attacks and strokes but may also regress the diabetes back to normal.
What preventative measures can people take so that they don’t develop diabetes?
Type 1 diabetes is a genetically linked immune problem, which can be triggered by various factors such as the environment and viruses, and as such, it is not possible at present to try and prevent it. There are some research projects, which are trying to identify a vaccine and other preventing techniques.
Type 2 diabetes is a condition, which closely follows lifestyle measures like poor diet, physical inactivity and consequent weight gain. Avoiding calorie rich foods on a regular basis (ready meals and fast foods), taking healthy exercise (at least 150 minutes of moderate physical activity per week) and avoiding stress helps to prevent diabetes onset.
Dr Jesse Kumar is Consultant Endocrinology at London Bridge Hospital (www.londonbridgehospital.london). Dr Kumar has a wealth of experience in diabetes, general medicine, lipids, thyroid, adrenal and calcium.