DIABETES: 4 Million UK Diabetics Already.....with Another 13 Million Waiting!

Diabetes seems now to be a word or an ailment which is so commonly found in everyday vocabulary, yet twenty years ago, it was unheard of outside medical circles. It seems that huge numbers of people are now diabetic, pre-diabetic or know someone else who is diabetic. And this is growing!

According to Public Health England, around 4 million people in the UK currently have diagnosed diabetes. The bad news is that this will rapidly rise to around 5.5 million people in only the next three years, demonstrating that this disease is rapidly getting out of control, as more and more people succumb to its grip.

The problem does not end there, as the latest data also shows that around 14 million people in the UK are ‘pre-diabetic’ meaning that they are about to enter diabetes probably in the next few years making these stats even worse.

What exactly is diabetes and is it really that serious?

We have to start with understanding three key biochemicals first. The first is sugar(or technically speaking glucose), and the second two are both hormones. One is the well-known insulin, while the second is another hormone called glucagon. Starting with sugar or glucose, this particular nutrient is critical for energy production in our cells. In fact, all our cells need glucose in order to function, without which they would die, hence the importance of glucose, despite its ‘evil’ status within the health popular press.

At any one time a 70 kilogram person will have around 4 grams or just a teaspoonful of glucose circulating in our bloodstream. This amount is an incredibly small and dilute amount of sugar which is important for what we call ‘homeostasis’ ie the body’s ability to maintain a constant metabolic state throughout. This concentration of sugar must be maintained throughout our lives, day and night. Too much sugar is called hyperglycaemia and too little is hypoglycaemia, both of which are serious threats to our health.

The brain extracts around 60% of sugar from the blood as measured in a person at rest , showing the brain’s huge need for sugar to maintain its function. But other organs and tissues also need sugar too and at just the right level to maintain an efficient metabolism.

Sugar is actually stored in the body in two major sites, notably the muscles which house around 400 grams of sugar overall, in the form a polymer called glycogen, and also in the liver, which can store around 100 grams, also as glycogen. Muscle glycogen is used to create energy, while liver glycogen is released into the bloodstream by the hormone glucagon, to manage glucose levels in the blood.

Why Insulin Control is So Important

Every time we ingest any carbohydrate, it will be broken down into smaller units usually glucose and it is this glucose that is used as the body's primary energy source.

Glucose (sugar) is needed by all cells as a main source of energy, but these cells firstly need to allow glucose into their inner workings. This happens via glucose ‘transporters’ in a healthy person where the glucose easily enters the cell and plays a part into the cell’s energy manufacturing process, in one particular part of the cell called the mitochondria. It is within these mitochondria that glucose is turned into vital energy, usually via the Kreb cycle, otherwise known as the Citric Acid Cycle and also the TCA Cycle. It seems that this is such an important part of our biochemistry that it has been named three times!.

However, in order for the cell to allow entry of the glucose, insulin is required first and if blood insulin is present at too low a level, then cells will not be able to absorb enough glucose. In all cells, there are insulin ‘receptors’ and it is these receptors that help open the ‘window’ to glucose, rather like a lock and key.

Insulin is a key hormone that is made in the pancreas, in specialised cells called beta cells. If the pancreas is not working properly and failing to produce enough insulin, then blood glucose will be poorly absorbed into the cells causing a whole host of health issues.

Another issue is insulin resistance, which is when cells are ineffective in absorbing the glucose, even in the presence of insulin.

Type 1, Type 2 and Gestational Diabetes - What’s the Difference?

Within the 4 million or so people in the UK who have diabetes, only around 8% of those patients will typically have Type 1 diabetes (T1D). The rest will have type 2 (T2D) which is obviously the far more common variety and the one which is much more associated with lifestyle and diet.

Type 1

With type 1 diabetes, insulin levels are typically either very low or absent altogether, which means that cells will not be capable of absorbing glucose efficiently. Type 1 diabetics will therefore need regular injections of insulin if they are to avoid serious health problems. Controlling the amount of insulin needed throughout the day is extremely important and after some coaching by the GP, most people grasp its management fairly quickly. Basically, insulin needs to be injected in line with the amount of sugar and carbohydrate in the diet and basically replaces what the pancreas would previously have done automatically. Some insulin users will have access to a continuous glucose monitor (CGM) which has the capability of measuring blood glucose on literally a continuous basis with the data going directly to their phone, allowing them to understand which foods cause the greatest spike in blood glucose levels post meal.

T1D is commonly diagnosed in children but still adults can become type one diabetic later in life. In fact, type 2 diabetics can also progressed to becoming a type one diabetic if the pancreas fails to produce enough insulin or gives up entirely.

Type 2

Type 2 diabetics (T2D) will have a pancreas which is working to some extent and may be working effectively, but for some reason there is what the scientists called insulin resistance, which is where the cells, despite the presence of insulin, are resistant to glucose uptake. Even now, scientists are still not sure as to why cells behave in this insulin resistant fashion. Both type 1 and type 2 diabetics will both be prone to higher than normal glucose levels in their blood or hyperglycaemic to use the technical term.

 Many of the type 2 diabetics can control to some extent their diabetes by adjusting their lifestyle in terms of increasing their exercise levels but also reducing sugar intake in their diet.

Gestational

However, there are many other types of diabetes, the third most common is the fairly well known gestational diabetes which typically will occur during the third trimester of pregnancy. Only around 5% of pregnant women will be affected, but this can usually disappear after birth. It can be simply diagnosed as parts of the regular check-up and is usually picked up by an oral glucose tolerance test, otherwise known as an OGTT. Those women who do end up acquiring gestational diabetes will have a higher probability of becoming diabetic later in life, so this will be an ongoing risk factor which needs to be managed carefully by their GP.

The overall cost of diabetes patients to the NHS is estimated to be around £10 billion per year and of course, this will significantly increase over the next three to four years as another one to two million diabetics are added to the diabetic register.

What are the Symptoms or Warning Signs

Symptoms of diabetes can include the following:

• Thirstiness and hunger, because the cells will be literally starving due to lack of glucose intake for energy.
• Frequent urination can also be a common symptom, especially at night and this occurs because the body is attempting to flush out as much glucose as possible in order to maintain blood glucose levels at a safer level.
• Weakness and fatigue
• Blurred vision
• Tingling hands or feet
• Cuts will also take much longer to heal
• Dry and itchy skin.

What are the Risk Factors for Acquiring Diabetes

Being overweight or obese is a large risk factor and you will find that many diabetics are carrying far more extra weight than they should. In fact, the increase in diabetes over the last twenty years parallels the same curve in rising obesity levels, showing that there is a clear association between these two metabolic issues.

This risk of acquiring diabetes multiplies further with a sedentary lifestyle, with little exercise.

Obviously, a high sugar diet is a significant risk factor for diabetes, as is a hypocaloric (too many calories) diet. In general, those who tend to have a poor diet, high in processed food, sugar and salt plus being low in essential micro nutrients, will also have a greater risk.

Age and genetics are also significant risk factors, with the risk of acquiring T2D growing with age.But genetics , as in family history, also plays a role, as it does with so many other chronic diseases. However, by being ‘dealt a poor genetic hand’ does not necessarily mean that you will end up with type 2 diabetes, as there is so much that a person can do in terms of enhancing the quality of their lifestyle and diet to avoid or at least lessen the risk.

Diagnosing Diabetes

There are a variety of different diagnostic tests for diabetes, and these will measure either glucose levels in the blood, or better still, measure the ability of the body to clear glucose from the blood efficiently.

The simplest test is a random blood sugar measurement which can be done at the doctors surgery. The test can be taken at any time and is therefore very convenient. There is also no need to fast prior to the test being undertaken. This is simply a fingerpick test with the results being available instantly. The cut off is 200 mg/dL for diabetes.

A more precise test is the fasting glucose test, where the patient has had an overnight fast in order to better understand background glucose blood levels. Again, the finger prick test can accurately measure glucose levels with two cut off levels now. One for diabetes and the other for pre diabetes. These are 126 mg/dL and 100 mg/dL respectively.

A popular test is the HbA1c (glycated haemoglobin) test, which measures the average amount of glucose or sugar that has attached itself to haemoglobin over the last two to three months. The advantage of this test is that it is much more of an average estimation over many weeks and can give a better indication of longer-term glucose control, rather than a single point in time, as above. The test can be a vein draw or again, a simple finger prick, though the latter may not be quite as precise. There is no need to fast of course. Typically, the results are given as a percentage with a result of more than 6.4% (or >137 mg/dL) being in the diabetic region and 5.7% (or 117 mg/dL) or more in the prediabetic region.

Another test which is a good indicator of how effectively glucose is cleared or absorbed from the blood plasma is the Oral Glucose Tolerance Test or OGTT. In essence, this test will measure insulin resistance, which is a problem observed with diabetics and also pre-diabetics too.

For the test itself, the patient will have blood taken beforehand as a baseline measuring background glucose levels. Then will be the glucose drink, with further blood draws taken up to three hours, indicating how fast glucose is cleared from the system. The advantage of the OGTT is its ability to measure clearance in real time, demonstrating the body’s ability to both make the required amount of insulin, but also to confirm the clearance of glucose from the bloodstream in a timely manner. Insulin resistance would show a slower clearance compared to someone who did not have diabetes.

Health Risks of Diabetes

Though there is around 4 million people in the UK with diagnosed diabetes and another 14 million with pre-diabetes, there will be others too who are diabetic and are still not aware. Diabetes can be controlled well with drugs like metformin and insulin itself. However, if diabetes is left unchecked, then it can cause quite serious health problems which can be far reaching.

Common health problems observed with those having diabetes, includes the following:

 Eye problems (Retinopathy)

Some people with diabetes can develop an eye disease called ‘diabetic retinopathy’ which is the most common cause of preventable blindness. If retinopathy is picked up – usually from an eye screening test by an ophthalmologist - it can be treated and sight loss prevented.

In addition, those with diabetes are nearly twice as likely to develop pressure in the eye which can cause ‘glaucoma’ , which is a condition which causes damage to the optic nerve. If this important nerve is damaged, then loss of vision is unavoidable.

Foot problems

Diabetes induced foot problems are serious and can even lead to amputation if untreated. Diabetic neuropathy (nerve damage) can affect the feeling in your feet which in turn can cause the muscles around the foot to fail, causing damage.

Also, diabetes can affect blood flow too, known as diabetic vascular disease. This can affect the arms and legs which will be mean that infections, sores and cuts are much more difficult to heal. In serious cases this can lead to the need for amputations, though this is rare.

Heart attack and stroke

High blood sugar maintained over a long period of time can also damage blood vessels. Glucose or blood sugar tends to ‘stick’ to haemoglobin (glycated haemoglobin), increasing the risk of fatty deposits or atheroma in the walls of the blood vessels. Inflammation, leading to plaque formation is the main cause. In addition, blood vessel walls can become stiff, raising blood pressure and therefore the risk of stroke and heart attacks.

Kidney problems (Nephropathy)

One of the kidney’s roles is to filter blood, returning waste to the bladder as urine for subsequent excretion. Diabetes can cause damage to the filtration mechanism (glomeruli) of the kidneys over a long period of time making it harder to clear extra fluid and waste from the body. This is caused by high blood sugar levels and high blood pressure and can be recognised from a simple test which may indicate excessive levels of protein in the urine.

Nerve damage (Neuropathy)

Some people with diabetes may develop irreversible nerve damage caused by high blood sugar levels. The high sugar levels damage the small blood vessels that supply the nerves, causing nerve fibre damage, since key nutrients no longer can reach the nerves. This damage interferes with the normal signalling of messages to the nerves, leading to a change in sensation, numbness and tingling. The most common form is diabetic peripheral neuropathy which is damage in particular to the feet and hands. There are other forms of neuropathy too, such as sensory neuropathy, affecting sensation and motor neuropathy which affects the nerves which control movement.

Gum disease and other mouth problems

Diabetics will be three times more likely to suffer from dental problems, especially gum disease, which is caused by bacteria in the dental plaque, which grows on teeth making both toxins and acid too. As one might expect, too much sugar in the blood will also raise the risk of tooth decay due to acid producing bacteria which feed on the higher saliva sugar levels.

How to Avoid Entering Diabetes

As a final word, this is actually quite simple for  most people .

Eat well, move more and get support if you are overweight, as obesity significantly increases the risk of diabetes.

High sugar diets are bad for our health. Most people know this, but sugar does tend to enhance the aste of most foods and it is therefore hidden amongst all the other various ingredients on the label. A little sugar of course is perfectly fine, but as is usual, too much simply is going to cause a problem.

Exercise is another protection mechanism, where there are countless studies showing people who have entered diabetes, have been successful in reversing the condition simply with exercise. The combination of a balanced and healthful diet combined with regular exercise is the perfect recipe for lowering the risk of diabetes. However as people age and are less energised, then exercise does become more challenging, but nevertheless a necessary part of the healthy ageing process.

Those who are obese will unfortunately have a much higher risk of acquiring diabetes. But losing weight has been shown to dramatically reduce the risk and those who have undergone bariatric surgery, for example, are usually also successful in ridding themselves of this disease. Those who wish to read more about diabetes should look at the UK diabetes website which is full of a huge amount of very useful material and will be especially useful if you have diabetes of any sort. You can find this resource at www.diabetes.org.uk