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Diabetes and pre-diabetes: a sweet truth

Diabetes is rarely out of the news these days, with numerous statistics regarding its impact both on patients and NHS resources. However, there are ways to reduce your risk, says Rosalind Ryan.

Most of us know diabetes is something to do with not being able to process sugar properly, but the disease has a bigger impact on the body – and the NHS – than simply necessitating the avoidance of sweets. Diabetes UK, the country’s leading diabetes charity, says 3.9 million Britons have diabetes, while the NHS spends around £10bn every year treating the disease. Unfortunately, both sets of figures are set to rise and an estimated 11.5 million of us are believed to be at increased risk of getting type 2 diabetes.

What is diabetes?

There are two main types of diabetes: type 1 is more common in younger people and means you do not produce any insulin, while type 2 is more common in older people and means you either do not produce enough insulin or the body is resistant to the insulin produced. Either way, this means you cannot break down sugar (glucose) properly, so it builds up in the bloodstream, causing health problems. About 90 percent of all those with diabetes have type 2.

“Some people may not have any symptoms at all when they are diagnosed with type 2 diabetes,” says Douglas Twenefour, a clinical adviser for Diabetes UK [www.diabetes.org.uk]. For a checklist of common symptoms, see the box-out below. However, a number of risk factors can make you more likely to develop type 2:

  • being over 40 years old

  • being overweight or obese, especially weight carried around your middle

  • having high cholesterol

  • if you’ve ever had high blood pressure, a heart attack or stroke

  • a family history of diabetes

  • coming from an African-Caribbean, Black African, Chinese or South Asian background and being over 25.

Diabetes UK has an online tool [http://riskscore.diabetes.org.uk] where you can check your personal risk. Experts say these risk factors are not indicators just for diabetes. Professor Anthony Barnett, emeritus chair of medicine at Birmingham University and a consultant physician and diabetologist, says, “They’re also markers of an increased risk of heart disease and some common cancers, such as bowel cancer, kidney cancer and gynaecological cancers.” So reducing your diabetes risk factors potentially has a wider effect on your health.

What happens if I get diabetes?

“If diabetes is not managed properly, unfortunately, the cost to the person and their family can be devastating,” says Douglas Twenefour at Diabetes UK. Diabetes can lead to blindness (it is the leading cause of preventable sight loss in people of working age in the UK), kidney diseases, nerve damage, heart disease and stroke.

It can also cause problems with the feet and possibly amputations – if small cuts or wounds on the feet do not heal properly, it can lead to the loss of the leg. The cost of diabetes is financial, too. The NHS spends some 10 percent (£10bn) of its entire budget treating diabetes every year, with some £8bn on related conditions. This includes amputations (100 a week are carried out as a result of diabetes) and other complications.

Am I going to get diabetes?

It is not inevitable you will develop type 2 even if you have a number of risk factors, including raised blood glucose. This is sometimes called “pre-diabetes” or “borderline diabetes” – your blood sugar levels are elevated but not high enough to be called diabetic. A study published in the BMJ in 2014 estimated that a third of the UK’s adult population has pre-diabetes, but the term is not actively used in the UK.
If a blood test reveals you do have high blood glucose, diabetes is still avoidable. Professor Anthony Barnett says, “Over the next five years, 40 percent of those with pre-diabetes will develop diabetes, but 30 percent will revert to normal. It proves you can reduce your risk, even at this point.”

Protect yourself by making some simple lifestyle changes, such as giving up smoking, losing weight and doing some exercise. Being overweight is the single biggest risk factor for type 2 diabetes, while “the best way of improving insulin resistance is exercise”, according to the professor.

Ask your GP to refer you to a dietician for help with weight loss or healthy eating ideas, and aim for around 150 minutes of exercise a week – although this doesn’t have to be all at once. A 30-minute brisk walk or swim, at least five times a week, is just as effective.

Choose wholegrains over highly processed starchy foods like white bread or pasta. Eat more fruit and vegetables, nuts and oily fish, and up your pulses, too. Cut down on items high in added sugars, such as cakes, biscuits and fizzy drinks. Overall, read food labels and watch your portion sizes. Douglas Twenefour says, “It might sound boring, but it works!”

While type 1 diabetes has nothing to do with lifestyle and cannot be prevented, up to 80 percent of type 2 cases can be delayed – or avoided altogether – with some simple lifestyle changes. Now that’s one diabetes statistic that is good news.

Type 2: common symptoms

  • Needing the loo a lot more than usual, especially at night

  • Feeling more thirsty, so drinking more

  • Feeling much more tired than usual

  • Having cuts and bruises that take longer to heal

  • Suffering frequently from thrush

  • Losing weight without trying.

If you’re experiencing any of the above, make an appointment with your GP for a blood test as soon as possible.