Since 1996 the number of people with diabetes in the UK has risen from 1.4 million to nearly three million. Should current trends continue it is estimated that by the year 2025 diabetes prevalence will have reached four million. In particular, Type-2 diabetes has been expanding at an accelerated rate and has now become one of the world’s most common chronic health conditions. Three million people in the UK living with diabetes equates to 4.5 percent of the population, and the majority of these have Type-2 diabetes. In adults, 10 percent have Type-1 and 90 percent have Type-2. In children, 98 percent have Type-1. Because of the increasing trend for young people to be very overweight or obese, their levels of Type-2 diabetes, which was once almost unheard of, has now reached 2 percent. In the population as a whole, Type-2 diabetes is without doubt the most common form of the two diabetes.
What is diabetes?
Diabetes is a lifelong condition where the blood glucose levels are abnormally high. In Type-1 (the least common type) the cells in the pancreas gland which normally produce insulin are attacked by the immune system, resulting in a total absence of insulin. This causes blood glucose levels to rise dramatically. It affects about 10 percent of all people with diabetes and normally occurs in childhood, but almost invariably under the age of 40. In Type-2 diabetes, which affects 90 percent of people with the condition, either the body does not product sufficient insulin or the body has become less sensitive to its action. This form of diabetes is often associated with being overweight and is normally seen in the over 40s. For the three million people in the UK already diagnosed and the 850,000 who are not yet aware that they have it, a healthy lifestyle with fewer starchy foods and more regular exercise is always beneficial. In Type-2, lifestyle changes may even prevent the onset the diabetes in the first place.
Type-1 diabetes will always require regular injections of insulin, although this is not as daunting as it sounds. Most children quickly learn to painlessly inject and monitor their own blood sugars with the use of finger prick blood tests and glucose metres. Type-2 diabetes may be controlled through lifestyle measures and with a variety of medications that not only reduce blood sugar but also reduce cholesterol and other blood fats also. In severe Type-2 diabetes insulin may also be required.
The Diabetic Health Care Team do a fabulous job of educating people about their own condition and reassuring them that they can usually lead completely normal lives, in addition to showing them how to use the various treatments and blood testing metres. Regular checks ensure, as far as possible, that complications of diabetes do not occur. Patients can also be instructed how to adjust their treatments when required.
The best news to emerge in recent years is that for many Type-2 diabetics, the adoption of a healthy lifestyle can not only prevent the condition, but can also help avoid or minimise the need for treatment. Some people have even been able to come off the medication altogether (with approval from their doctors). Living with diabetes is more of an inconvenience than a burden, unless complications have occurred.
See also: Diabetes and Foot Care
Can you prevent Type-2 diabetes?
Type-1 diabetes occurs when your body’s immune system destroys the insulin producing cells in your pancreas gland. The trigger for this remains unknown. Type-2 diabetes is a little more complicated because it seems to be a combination of our genetic makeup, the lifestyle that we lead and environmental factors that put us at more risk of developing it. It is encouraging that we can all make changes in our lifestyles to reduce our risk of developing Type-2 diabetes. While some overweight people will never develop Type-2 diabetes and other people that are a healthy weight will develop it, on the whole, avoiding obesity and adopting a healthy lifestyle will reduce your risk in almost all cases.
Healthy eating
Eat regular meals
Skipping meals or eating just one large meal a day makes appetite control difficult, and can have a detrimental effect on blood glucose levels. Spread your calorie intake out over the day and carry a healthy packed lunch and healthy snacks with you.
Control your carbohydrate intake
It is carbohydrates and starchy foods that are converted to sugar in your blood, and an excess will cause weight gain. Choose varieties of carbohydrate that are more slowly absorbed, or in other words, have a lower glycaemic index. Good sources include granary, rye and pumpernickel bread, new potatoes, sweet potatoes, yams, oats and natural muesli, in addition to wholemeal pastas, basmati rice and easy-cook rice.
Cut down on fat
The body converts saturated fat to cholesterol, which can clot arteries and increase the risk of future heart disease and strokes, which diabetics are more prone too. Avoid full-fat dairy by switching to semi-skimmed or skimmed milk. Avoid creamy sauces and dressings in favour of tomato-based sauces. Avoid too much oil by steaming, grilling or baking food instead of frying. Pack in your vitamins and minerals by eating plenty of fruit and veg. Like fruit and veg, beans and pulses are also high in fibre, low in fat and inexpensive to buy. They can also help control cholesterol levels. Lentils, chickpeas, kidney beans, baked beans and can be incorporated into casseroles, soups, salads, bean burgers and low-fat hummus. Oily fish including mackerel, salmon, sardines and tuna are rich in omega-3 polyunsaturated fats, which have a protective effect against heart disease.
Cut back on sugar
Sugar has the highest glycaemic index of all carbohydrates and boosts blood glucose very quickly. Opt for a sugar-free diet and avoid drinks with added sugars. If you eat canned fruit, choose ones that are in juice rather than syrup, and consider using sweeteners instead of sugar. Get used to reading the nutritional labels on the food you buy to cut down your sugar intake.
Avoid too much salt
Excess salt intake can raise your blood pressure, increasing the risk of strokes and heart attacks. Most of us eat more than the recommended 6 grams of salt (or less) per day. Around 70 percent of the salt we consume comes from processed foods. Reduce your reliance on pre-prepared foods and experiment with different flavourings like pepper, herbs and spices.
Monitor your alcohol intake
Not only is alcohol a carbohydrate, but the alcohol content itself can reduce your motivation to keep on the straight and narrow when it comes to healthy eating.
Control your portion sizes
Even if you are eating the healthiest foods, if you are piling a large amount of food onto a large plate you are bound to put on weight. It’s about quantity as well as quality, so try to moderate your portion sizes. (See also, ‘Mediterranean Diet’, pp.66-70)
Keeping active
As well as helping your to maintain a healthy weight, physical activity increases the amount of glucose used by your muscles for energy. In doing so it can reduce blood sugar levels that may be rising too high. Exercise also helps your body use insulin more efficiently. This is why Type-1 diabetics can reduce the amount of insulin they need to inject when they take more exercise. Losing weight through exercise improves the management of Type-2 diabetes.
What exactly is pre-diabetes?
Pre-diabetes is a term that is increasingly being used, whereas in the past, doctors used to refer to it as borderline diabetes. It is closely allied to obesity and being overweight, but if undiagnosed or neglected will almost always progress into Type-2 diabetes.
Pre-diabetes means that your blood glucose levels are higher than normal, but not high enough to be classified as full-blown diabetes. Currently, it is thought that around seven million people in the UK are pre-diabetic and therefore at risk of developing Type-2 diabetes in the future. Usually, there are no symptoms, as they will only emerge once you actually have Type-2 diabetes. Risk factors include being overweight or obese, having a close relative who currently has diabetes, having abnormal blood fats or high blood pressure, being over the age of over 45 and having given birth to a baby who weighed more than 9lb (4.8kg).
Managing Type-1 diabetes
If you have Type-1 diabetes you will need to take insulin injections for the rest of your life. Managing Type-1 diabetes not only means monitoring your blood sugar levels and leading a healthy lifestyle, but learning enough about your condition to make small changes where necessary so you feel confident about the management of your own treatment.
Using a finger prick device to check your blood sugar levels at regular intervals and a blood glucose testing metre to provide immediate results makes a huge difference to controlling your condition and avoiding complications. The aim is that you lead as normal an active a life as possible, avoiding complications and become the master of your own disorder.
When you are first diagnosed with Type-1 diabetes the implications can be daunting. You will be referred to the Specialist Diabetes Care Team for treatment who will help you to understand the condition and give you the ability to monitor your progress closely. Since your body can’t produce any insulin at all, you will need to have regular insulin injections to keep your blood glucose levels within a satisfactory range. Gradually you will to learn how to match the insulin you inject into the food you consume, taking into account your blood glucose levels at all times and how much exercise you are doing. It is a skill that comes with time, needs to be practiced and constantly improved. There are even courses that teach these special skills.
Insulin comes in many different forms. Long-acting insulin lasts for a whole day, while short-acting varieties may last for just a few hours. Often treatment consists of one long-acting insulin injection at night and three short acting insulin injections during the day at meal times.
Islet transplantation is a new procedure for treating Type-1 diabetes. Healthy Islet cells from the pancreas of a donor are implanted into the pancreas of somebody with Type-1 diabetes, and there are insulin pumps which inject a small amount of insulin throughout the day using a tiny syringe worn on the trouser belt.
Avoidance of complications
Tight control of your blood sugar levels helps you to feel well at all times, and prevents potential long-term complications such as kidney disease, visual problems, heart attacks, strokes and arterial narrowing, for as long as possible.
Living with diabetes
Providing you learn as much about your condition as possible and control your blood sugars strictly, you can minimise your risk of developing complications. This means eating a well-balanced diet, exercising regularly and avoiding behaviours that worsen the risk of complications. Stopping smoking (see also p.84) will reduce your risk of heart and circulatory disease, and adopting an overall healthy lifestyle means that living with Type-1 diabetes may be no more than a minor social inconvenience rather than a chronic long-term health condition.
SEE ALSO: Are you at risk of diabetes?
