Diabetes is a long-term condition that causes a person’s blood sugar level to become too high. This can lead to serious damage to the eyes, blood vessels, heart, kidneys, and nerves.
According to Diabetes UK, more than 4.9million people in the UK have diabetes. 13.6million people are now at increased risk of type 2 diabetes and 850,000 people in the UK are currently living with type 2 diabetes but haven't yet been diagnosed1.
And the numbers are on the increase. Type 2 diabetes accounts for 90% of all diabetes cases (in adults and children). Type 1 diabetes accounts for 8% of all diabetes cases, and about 2% of the cases have other rare types of diabetes.
Research has shown that adjusting diet, keeping physically active and sustained weight loss can reduce the risk of type 2 diabetes by 50%.2
This means it is within our power to reduce our risk of developing type 2 diabetes and delaying the onset of complications by making simple lifestyle choices. These simple lifestyle choices can prevent, help manage and even reverse type 2 diabetes. All forms of diabetes can lead to serious health issues if not managed properly.
So, it’s important to understand what it’s all about and what you can do to help yourself, or friends and family members who may be at risk of developing type 2 diabetes.
Hema Love, Pharmacist with AXA Health’s 24/7 health support line, answers some of your questions about diabetes. What causes it? How to recognise the symptoms, and the importance of diet and lifestyle in managing and preventing type 2.
Q. What is diabetes?
Diabetes occurs when your body doesn’t produce enough insulin or is unable to use the insulin it produces as well as it should (insulin resistance).
The hormone insulin is naturally produced in the pancreas. It important because it helps move glucose out of the blood and into our cells, where it’s converted into energy and used for energy and repair. When you have type 2 diabetes, the lack or reduced insulin or insulin resistance causes a build-up of glucose – a type of sugar – in the blood, which can lead to serious health complications, including:
- heart disease,
- kidney failure
- and strokes if not controlled.
Diabetes UK have further information on how to live with diabetes.
Q. What’s the difference between type 1 and type 2 diabetes and is one more serious than the other?
In both type 1 and type 2 diabetes the blood sugar levels can be high. Having high blood sugars whether you have type 1 or type 2 diabetes lead to serious health conditions.
Type 1 diabetes
In type 1 diabetes your body attacks the cells that produce insulin, so the body cannot make its own natural insulin.
It tends to start earlier in life (usually in childhood or teenage years) and must be treated with insulin injections from the outset. Type 1 diabetes is less common than type 2. Whereas type 1 occurs when the body produces no insulin at all, type 2 occurs when the body doesn’t produce enough insulin or when the cells in the body don’t react to insulin as they should (known as insulin resistance).
The hormone insulin is important because it helps control the amount of sugar in the blood. Produced by the pancreas, insulin works by moving glucose out of the blood and into cells, where it’s broken down into energy. If you don’t have diabetes, your pancreas senses when glucose has entered your bloodstream and releases the right amount of insulin; so manages the amount of glucose that enters your cells.
Similarly, if blood glucose levels fall too low a process is triggered that replenishes glucose levels in the blood from reserves in the body. In this way the level of glucose in the blood is kept within the ‘normal’ range. But if you have diabetes, this system doesn’t work as it should.
Type 2 diabetes
Type 2 is more closely linked to being overweight and your ethnic background. It tends to run in families, typically starts in adulthood and can often be treated with diet, weight control and tablets, at least in the early stages.
There is no mild form of diabetes. Regular treatment and follow-ups are crucial for both type 1 and type 2 diabetes as both can cause serious complications if not properly controlled.
Q. Why are blood sugar levels important?
If blood sugar falls too low, meaning below 4mmol/l it is classified as a hypoglycaemia, commonly referred to as ‘hypo’. Low blood sugars can be dangerous if not treated quickly.
In people who suffer from diabetes, ‘hypos’ can also be triggered if you skip a meal or wait too long between meals. It can also happen after exercising or if you drink alcohol on an empty stomach.
The NHS have more details on the symptoms and how to manage hypoglycaemia.
Some medicines for type 1 and type 2 diabetes – insulin injections and tablets called sulphonylureas and glinides or prandial glucose regulators – can drop blood sugar too much, causing a hypoglycaemic event.
Your GP, doctor or diabetes specialist will warn you of this effect when they first prescribe this type of medication. The patient information leaflet that accompanies the medicine will also provide this type of information, so it is always good to read the leaflet before taking any medication.
If blood sugar levels rise too high, hyperglycaemia (hyper) may occur. With very high levels, you can become dehydrated and even comatose, and may need hospital treatment.
Read more on high blood glucose levels (hyperglycaemia) from the NHS.
Q: What are the most common symptoms of diabetes?
In type 1 diabetes, the insulin-producing cells in the pancreas are destroyed by the immune system and therefore cannot produce insulin. Type 1 comes on very quickly, often within days or weeks.
The most common symptoms include:
- Increased and constant thirst – termed polydipsia
- Producing excess urine which causes someone to go to the toilet to pass urine more frequently than usual – termed polyuria
- Extreme fatigue or tiredness
- Blurred vision
- Unexplained weight loss.
With type 2, the pancreas either produces inadequate amounts of insulin, or the body is unable to use the insulin that is naturally produced (insulin resistance). Often linked with diet and lifestyle, type 2 is usually slow to develop and can often be missed.
The most common symptoms include:
- Producing excess urine which causes someone to pass urine more frequently – termed polyuria - particularly at night
- Increased hunger and/or feeling hungry not long after eating a meal
- Increased thirst
- Blurred vision
- Repeated thrush infections in the vagina (candidiasis)
- Wounds that take a long time to heal
- Itching of the skin, especially around the genitals.
Q. Is there a cure for diabetes?
Diabetes is a long-term condition, often lifelong. Currently there’s no known cure. However, the disease can be controlled - often very successfully.
For people with type 1 diabetes that means taking insulin – either by regular injection or through a pump, which drip feeds the insulin into the body throughout the day.
There are many different types of insulin available these days, in very many forms such as throw away pens, known as penfill, or reusable pens.
You and your diabetes nurse specialist will work out which insulin and the device works the best for you.
Type 2 diabetes however, can be controlled through diet and exercise initially, although tablets are often required as the condition progresses to improve your response to or increase the level of insulin. Sometimes injections are needed to help maintain healthy blood sugar levels.
Q. What is prediabetes?
Prediabetes occurs when your blood glucose levels are higher than they should be, but not high enough to qualify as type 2 diabetes.
This puts you at increased risk of developing type 2 diabetes. In many cases, changes in diet and being more active can delay or prevent the onset of full-blown diabetes.
Q. I’m following a healthy diet with reduced salt and sugar and exercise regularly and yet nothing in my body changes - BMI, weight and waist size have all stayed the same and I’m still at risk of/borderline type 2 diabetes. Is there anything else that an individual can do to make a difference?
If you’re exercising regularly - at least 30 minutes a day - and eating a healthy calorie-reduced diet and you’re not seeing any change in your BMI or waistline, you may need to see your GP to exclude any underlying disorder and any appropriate treatment option that may be open to you.
If your Body Mass Index is 35kg/m2 then you may benefit from having treatment with Semaglutide injections available through your GP.
Q. I am trying to limit my consumption of sugar to the Recommended Daily Intake (RDI) of 90 grams. Does the sugar in fruit and honey count towards this amount?
Yes - all sugars count, including fruit sugars. Reducing the amount of carbohydrates, so that you eat less than 130g a day, can also help. This does not however, mean cutting out carbohydrates from your diet.
Q. How and why does diabetes affect your feet?
Foot problems are much more common in people with diabetes because of the damage that raised blood sugars can cause to sensation and circulation.
Two specific complications of diabetes can be:
Peripheral arterial disease – a common condition which can cause poor circulation to your feet.
Peripheral neuropathy – nerve damage.
Signs to look out for include:
- Changes to the general condition of the skin on your feet, e.g., cracks, splits, or broken skin, which can increase the likelihood of infection
- Impaired sensation or numbness, meaning you may not feel an injury to your foot, or if a shoe it is rubbing, either of which may lead to infection
- Changes to the shape of the feet, including thickened, hard skin forming on areas experiencing pressure or rubbing, which may in turn increase pressure and cause damage to the underlying tissues.
If you have diabetes, you’ll be offered a yearly foot care check as part of your ongoing review.
Q. My sister is pregnant and has been diagnosed with diabetes. Will this be with her for the rest of her life, or will it go when she's had the baby?
For those who are diagnosed with diabetes during pregnancy (gestational diabetes), blood glucose levels usually return to normal once the baby is born and any medication is usually stopped.
Blood tests will be taken before your sister is discharged after the birth to make sure this has happened, with a follow up fasting blood test at the six-week postnatal check.
Those who’ve had gestational diabetes have an increased likelihood of developing gestational diabetes in future pregnancies and type 2 diabetes in later life.
Find out more in our NHS gestational diabetes factsheet.
If you are concerned about any of the symptoms above and think you might be diabetic, or you’re worried about your current diabetes diagnosis, then contact you GP and seek medical help.