Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly. Glucose comes from the digestion of starchy foods such as bread, rice, and potatoes, from sugar and other sweet foods, and from the liver which makes glucose.
Insulin is vital for life. It is a hormone produced by the pancreas, that helps the glucose to enter the cells where it is used as fuel by the body. The main symptoms of untreated diabetes are increased thirst, going to the loo all the time – especially at night, extreme tiredness, weight loss, genital itching or regular episodes of thrush, and blurred vision.
There are two main types of diabetes. These are:
Type 1 diabetes, also known as insulin dependent diabetes
Type 2 diabetes, also known as non insulin dependent diabetes
Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. It is treated by insulin injections and diet and regular exercise is recommended.
Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people often appears after the age of 25. It is treated by diet and exercise alone or by diet, exercise and tablets or by diet, exercise and insulin injections. .
The main aim of treatment of both types of diabetes is to achieve blood glucose and blood pressure levels as near to normal as possible. This, together with a healthy lifestyle, will help to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.
The main symptoms of diabetes are:
going to the loo all the time – especially at night
genital itching or regular episodes of thrush
Type 1 diabetes develops much more quickly, usually over a few weeks, and symptoms are normally very obvious.
In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems.
Diabetes is a common health condition. About 1.8 million people in the UK are known to have diabetes that’s about three in every 100 people. And there are an estimated one million people in the UK who have diabetes but don’t know it. Over three-quarters of people with diabetes have Type 2 diabetes.
Although the condition can occur at any age, it is rare in infants and becomes more common as people get older.
Type 1 diabetes
Type 1 diabetes develops when the insulin-producing cells in the pancreas have been destroyed. Nobody knows for sure why these cells have been damaged but the most likely cause is an abnormal reaction of the body to the cells. This may be triggered by a viral or other infection. This type of diabetes generally affects younger people. Both sexes are affected equally.
Type 2 diabetes
Type 2 diabetes used to be called ‘maturity onset’ diabetes because it usually appears in middle-aged or elderly people, although it does occasionally appear in younger people. The main causes are that the body no longer responds normally to its own insulin, and/or that the body does not produce enough insulin.
People who are overweight are particularly likely to develop Type 2 diabetes. It tends to run in families and is more common in Asian and African-Caribbean communities. Some people wrongly describe Type 2 diabetes as ‘mild’ diabetes. There is no such thing as mild diabetes. All diabetes should be taken seriously and treated properly.
Although diabetes cannot be cured, it can be treated very successfully. Knowing why people with diabetes develop high blood glucose levels will help to you understand how some of the treatments work.
Blood glucose levels
When sugar and starchy foods have been digested, they turn into glucose. If somebody has diabetes, the glucose in their body is not turned into energy, either because there is not enough insulin in their body, or because the insulin that the body produces is not working properly. This causes the liver to make more glucose than usual but the body still cannot turn the glucose into energy. The body then breaks down its stores of fat and protein to try to release more glucose but still this glucose cannot be turned into energy. This is why people with untreated diabetes often feel tired and lose weight. The unused glucose passes into the urine, which is why people with untreated diabetes pass large amounts of urine and are extremely thirsty.
Type 1 diabetes is treated by injections of insulin and a healthy diet. Type 2 diabetes is treated by a healthy diet or by a combination of a healthy diet and tablets. Sometimes people with Type 2 diabetes also have insulin injections, although they are not totally ‘dependent’ on the insulin.
Treatments for Type 1 diabetes
People with Type 1 diabetes need injections of insulin for the rest of their lives and also need to eat a healthy diet that contains the right balance of foods. Insulin cannot be taken by mouth because it is destroyed by the digestive juices in the stomach. People with this type of diabetes commonly take either two or four injections of insulin each day.
If you or someone close to you needs insulin injections, your doctor or diabetes nurse will talk to you, show you how to do them and give you support and help. They will also show you how you can do a simple blood or urine test at home to measure your glucose levels. This will enable you to adjust your insulin and diet according to your daily routine. Your doctor or diabetes nurse will advise you what to do if your glucose level is too low.
If you have Type 1 diabetes, your insulin injections are vital to keep you alive and you must have them every day.
Treatments for Type 2 diabetes
People with Type 2 diabetes need to eat a healthy diet that contains the right balance of foods. If your doctor or diabetes nurse finds that this alone is not enough to keep your blood glucose levels normal, you may also need to take tablets.
There are several kinds of tablets for people with Type 2 diabetes. Some kinds help your pancreas to produce more insulin. Other kinds help your body to make better use of the insulin that your pancreas does produce. Another type of tablet slows down the speed at which the body absorbs glucose from the intestine.
People with diabetes have a higher chance of developing certain serious health problems, including heart disease, stroke, high blood pressure, circulation problems, nerve damage, and damage to the kidneys and eyes. The risk is particularly high for people with diabetes who are also very overweight, who smoke or who are not physically active.
You will greatly reduce your risk of developing any of these complications by controlling your blood glucose and blood pressure levels, and by eating healthily and doing regular physical activity.
Regular medical check-ups
In the last 10 to 20 years, the care for people with diabetes has improved dramatically. One of the most important developments has been improved methods of screening which will help your doctor to pick up any health problems at an early stage so they can be treated more successfully.
This is why having regular medical check-ups, at least annually, is so important.
If you have diabetes, you will have to make some changes to your way of life. However, by sticking to your treatment, monitoring your condition and following a generally healthy lifestyle, you should be able to continue your normal, day-to-day life and take part in the activities you have always enjoyed.
You may need to change your eating habits.
If you smoke
Smoking is particularly dangerous for people with diabetes as it greatly increases the chance of developing a serious health problem. If you smoke, it is very important that you quit now.
It is a good idea to take up some form of regular physical activity, such as walking, swimming, dancing or cycling. Consult your doctor or diabetes nurse before taking up any regular exercise, particularly if you are overweight.
Following your treatment plan
It is very important that you follow the treatment that your doctor or diabetes nurse has advised. You will feel much better if you keep your blood glucose levels as near normal as possible. Blood glucose levels are measured in millimols per litre of blood. This is shortened to mmol/l. You should aim for a level of 4 – 7 mmol/l before meals, rising to no higher than 10 mmol/l two hours after meals. Your doctor or diabetes nurse will advise you on what is best for you. They can also advise you on the many gadgets available that can help you to monitor your blood glucose levels.
Diabetes has a lot of misconceptions, these are a few of them:
You can catch diabetes from someone else
No. Although we don’t know exactly why some people get diabetes, we know that diabetes is not contagious – it can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly Type 2 diabetes. But environmental factors also play a part.
Eating too much sugar causes diabetes
No. Diabetes is caused by a combination of genetic and environmental factors. However, being overweight does increase your risk of developing Type 2 diabetes, so if you have a history of diabetes in your family, a healthy diet and regular exercise are recommended to control your weight.
Type 2 diabetes is mild diabetes
No. There is no such thing as mild or borderline diabetes. All diabetes is equally serious, and if not properly controlled can lead to serious complications.
If you’ve got Type 2 diabetes, members of your family may also be at risk
Type 2 diabetes can be inherited. So if you’ve got Type 2 diabetes, other members of your family may also be at risk, particularly if they:
are over the age of 40
are of Asian or African-Caribbean origin
have a history of Gestational diabetes (diabetes in pregnancy).
People with diabetes eventually go blind
Although diabetes is the leading cause of blindness in people of working age in the UK, research has proved you can reduce your chances of developing diabetes complications – such as damage to your eyes – if you:
control your blood pressure and glucose levels
maintain your ideal body weight
give up smoking.
It’s not safe to drive if you have diabetes
Providing you are responsible and have good control of your diabetes, research shows that people with diabetes are no less safe on the roads than anyone else. Nevertheless, the myth that people with diabetes are not safe persists, and Diabetes UK is currently campaigning against legislation that prevents people who treat their diabetes with insulin from driving certain vehicles.
People with diabetes can’t play sport
Tell that to Steve Redgrave, Olympic gold medal-winning rower; Gary Mabbutt, ex-captain of Tottenham Hotspurs; or the many other people with diabetes who take part in the London marathon every year. People with diabetes are encouraged to exercise as part of a healthy lifestyle. Keeping active can help avoid complications associated with diabetes, such as heart disease.
However, if you treat your diabetes with insulin or certain tablets, you should be careful to avoid having a hypo (low blood glucose level) when doing strenuous exercise. You may need to reduce your insulin dose and should carry a high-sugar snack with you in case your blood glucose levels fall too low. It is a good idea to discuss strenuous exercise with your care team before embarking on any new exercise plan.
People with diabetes are more likely to get colds and other illnesses
No. You are no more likely to get a cold or another illness if you’ve got diabetes. However, people with diabetes are advised to get flu jabs. This is because any infection interferes with your blood glucose control, putting you at risk of high blood glucose levels and, for those with Type 1 diabetes, an increased risk of ketoacidosis.
People with diabetes can’t eat sweets or chocolate
Sweets are no more out of bounds to people with diabetes than they are to the rest of us, if eaten as part of a healthy diet, or combined with exercise. And people who take certain tablets or insulin to treat their diabetes may sometimes need to eat high-sugar foods to prevent their blood glucose levels falling too low.
If you have diabetes you should only eat small amounts of starchy foods, such as bread, potatoes and pasta
No. Bread, potatoes, cereals, rice and pasta should be the basis of all your meals and snacks. This is because these foods help you to keep your blood glucose levels steady. Wholemeal or wholegrain starchy foods are also a good source of fibre, which helps keep your gut healthy.
People with diabetes should eat special diabetic foods
The healthy diet for people with diabetes is the same as that recommended for everyone – low in fat, salt and sugar, with meals based on starchy foods like bread and pasta and plenty of fruit and vegetables. Diabetic versions of sugar-containing foods offer no special benefit. They still raise blood glucose levels, are usually more expensive and can also have a laxative effect.
Having diabetes means you can’t do certain jobs
There are lots of myths about the kinds of jobs you can and can’t do if you have diabetes. However, it is true that there are some jobs that people who treat their diabetes with insulin aren’t allowed to do. These include:
cabin crew with most airlines
any job that needs a large goods vehicle or passenger carrying licence
working offshore, including work with most big cruise liners – even as a caterer you won’t pass the offshore certificate
any job with the Post Office that involves driving
cab or taxi licences – some local authorities have a complete ban.