Diabetes

Diabetes mellitus is a lifelong, chronic condition that is characterised by the body's inability to control glucose levels in the blood.

There are two main types of diabetes:

Type 1 affects 20 per cent of people with diabetes and normally develops in people under the age of 40, most commonly during childhood. In this case insulin production is severely reduced, since most or all of the cells that produce insulin in the pancreas have been destroyed. Insulin is the hormone responsible for converting glucose into energy.

Type 2 is the most common form of diabetes, occurring in 80 per cent of cases. It normally develops in people over the age of 40 and occurs when either the pancreas produces insufficient levels of insulin or the insulin being produced is no longer as effective.

Complications associated with both types of diabetes include a higher risk of coronary heart disease, stroke, kidney failure, lower limb amputations and blindness. 

Causes and Risk Factors 

Nobody knows for sure the reason why Type 1 diabetes develops and why the insulin-producing cells in the pancreas become damaged. The most likely cause is an abnormal reaction of the body to these cells, triggered by a viral or some other infection.

However, there are known risk factors associated with the development of Type 2 diabetes, even if the mechanism is not well understood. These are:

• People with a family history of diabetes.
• People aged between 40 and 75.
• People of Asian or African-Caribbean origin.
• People who are overweight or obese.
• Women who have had a baby weighing more than 4kg (8lb).

In fact, four out of five people with Type 2 diabetes are obese. Recent evidence has shown that tackling obesity may prevent 50 per cent of new cases of Type 2 diabetes.

Diagnosis and Screening 

Type 1 diabetes usually presents with symptoms of extreme tiredness and excessive thirst that develop very quickly and can result in emergency admission. Uncontrolled hyperglycaemia (raised blood glucose) can lead to ketoacidosis, a serious condition that can cause multiple system failure and death.

Type 2 diabetes develops more slowly, with patients being asymptomatic for many years. In fact, a person has normally lived with Type 2 diabetes for on average eight years before it is diagnosed, with up to 50 per cent of people having established complications on diagnosis. These complications need not have developed, had it been diagnosed earlier. Recognising the symptoms (e.g. increased thirst, frequent passing of urine, extreme tiredness, weight loss, genital itching & blurred vision) through raising public awareness and introducing a screening programme are both key.

Management 

The maintenance of blood glucose levels as near to normal as possible is the primary objective in diabetes management. The development of complications can be reduced with good glycaemic control. People with Type 2 diabetes can manage their diabetes either through a healthy and balanced diet or by combining diet with tablets. There are several kinds of tablets for people with Type 2 diabetes. Some help the pancreas to produce more insulin, others help the body make better use of the insulin that is produced, while others slow down the speed at which glucose is absorbed in the intestine.

Blood glucose levels should be monitored to ensure that the levels are kept as near to normal. Target levels are between 4-7mmol/l before meals, rising to no higher than 10mmol/l two hours after a meal. There are a number of blood glucose meters available to allow people with diabetes to self-monitor their blood glucose levels wherever they may be.

Maintaining good blood pressure levels is also important in reducing the risk of long-term complications. Weight should be lowered, if overweight, and smoking should be ceased. Regular exercise is also important. Regular check-ups of eyes and feet should be carried out alongside laboratory tests that monitor compliance and/or complication development. These include the HbA1c test for measuring long-term blood glucose control; kidney function tests and blood fat tests (lipids, cholesterol & triglyceride).

Although diabetes is a life-long, chronic condition, if it is managed well, the quality of a person's life need not be severely affected and the risks of developing long term complications can be significantly reduced.